Hans van den Heuvel

4 Table 1. The ten-question preeclampsia symptom checklist in the telemonitoring platform, to be answered with Yes or No buttons. Do you have headaches? Do you have visual problems? Do you have a tight, band-like feeling around the upper stomach? Do you experience severe upper abdominal pain? Do your fingers feel numb? Do you feel nauseous? Do you have ankle, hand or face swelling? Do you have contractions? Do you have vaginal fluid loss? Do you have vaginal bleeding? In addition to blood pressure, data is also collected with the use of an in-app symptom checklist. This checklist contains 10 yes/no questions based on symptoms that occur in (the development of) hypertensive conditions as well as general pregnancy symptoms to continue to pay attention to pregnancy as a whole (Table 1). Both types of symptoms were included in the app to ensure pregnant participants could report all pregnancy-related symptoms from home for safety reasons. After uploading, the measurements are visible for both the patient (in the app, Figure 1) and the health care provider (in the existing electronic patient file). Participants were asked to submit their BP and symptom checklist for three consecutive weeks onMonday to Friday before 10.00 AM, resulting in a study period of 15 telemonitoring days in total. Standard daily alerts (push notifications) were sent at 7.00 AM to ask to start their measurements. Values exceeding the set threshold values led to alerts on the monitoring dashboard for health care providers. The acquired data was reviewed by an obstetric care professional [SK] every weekday at 10.30 AM. In this normotensive study population, BP alerts were set for a systolic value of >140 mmHg or diastolic >90 mmHg and / or an increase of 20 mmHg compared to the previous measurement. These thresholds were chosen as they indicate new-onset of gestational hypertension following international consensus, but all values can be altered in the dashboard to provide individual care. 9-11 The system was set to alert for the symptom checklist if 1 or more of the 10 questions was answered as a present symptom (Table 2). The alerts were reviewed with a protocol taking into account several combinations of hypertension and symptoms. If needed, the researcher would consult the obstetrician and subsequently contact the participant to advice one of the following: 1) expectant management or 2) same-day clinical assessment of blood pressure and symptoms and 3) if necessary with blood and urine analysis. To ensure patient safety, all alerts in the dashboard had to be switched off manually after processing the protocolled steps. FEASIBILITY STUDY OF BLOOD PRESSURE TELEMONITORING IN PREGNANCY 57