Hans van den Heuvel

4 measurements for a longer period to a healthy pregnant population. However, the future target population will consist of women with increased risk for hypertensive disorders in pregnancy. The observed participation grade and compliance rate might improve when the system is used for high risk women, with an actual increased risk for hypertension as an incentive for self monitoring. One participant met all inclusion criteria but was diagnosed with chronic hypertension during the study period. The use of the platform was thus beneficial in the early detection of new onset of hypertensive disease, which is one of the conceptual advantages of repeated remote monitoring in pregnancy. The other, healthy, participants had a high educational level which could have biased the results. Our study shows that many alerts of symptoms occurred without immediate need for further action, after reviewing the combination of symptoms with the up-to-date BP. This is one of the conclusions that proved to be very useful for our evaluation of the system. Future telemonitoring in prenatal care could make use of the symptom checklist. However, from the results of our study, we conclude that in terms of usability, the standard symptom checklist should only be uploaded during periods of hypertension (of BP >140 / >90 mmHg) or accidental raises in BP. Depending on the intended use of the platform, questions about general pregnancy symptoms could wither be excluded or made optional for future research or implementation. Individual protocols for timing and frequency of remote monitoring can be developed after risk stratification within specific groups of pregnancy complications or comorbidities. To assure patient safety, patient instructions should always include the need to call the clinic in case of emerging symptoms outside office hours. Recommendations for further research include updated versions of patient instructions (to obtain correct measurements and to enhance compliance rates) and updated protocols and flowcharts (for alarm evaluation for our telemonitoring team). In future implementation of this strategy, several routes of patient-clinician-communication are possible. In our centre, in this feasibility study, we chose to place a care provider for triage between patient and physician. In a different approach, it is also possible to train physicians how to review alerts themselves and communicate with patients based on the daily observed measurements. However, if telemonitoring is implemented to study the use of health care resources or cost-effectiveness, organizations may benefit from a task shift from physician to specialized nurse of midwife regarding the home monitoring or alert reviewing, under the supervision of a gynaecologist. Future trials should investigate the effects of the platform on perinatal outcomes, patient experiences and cost-effectiveness, as well as the opinion of health care providers. This feasibility study in uncomplicated pregnancy shows that a digital platform with telemonitoring of blood pressure self-measurements and symptom scores can be used in pregnancy care. While reassuring results from home do not appear in the daily alarm system, action fromhealth care providers during remote monitoring is only needed in case of alarming results. The possibility to monitor the combination of BP values with preeclampsia FEASIBILITY STUDY OF BLOOD PRESSURE TELEMONITORING IN PREGNANCY 63