Department of Obstetrics, University Medical Center, Utrecht University, Utrecht, Netherlands.
Department of Obstetrics and Gynaecology, Erasmus Medical Center, Erasmus University, Rotterdam, Netherlands.
JMIR Mhealth Uhealth. 2020 Oct 28;8(10):e18966. doi: 10.2196/18966.
Daily monitoring of fetal and maternal conditions in complicated pregnancies leads to recurrent outpatient visits or (prolonged) hospitalization. Alternatives for hospital admissions include home-based monitoring with home visits by professionals or telemonitoring with self-measurements performed by pregnant women and uploaded for in-clinic assessment. For both alternatives, cardiotocography and blood pressure measurement can be performed at home. It is unknown to what extent, for which reasons, and for which pregnancy complications these strategies are used.
This study aims to assess the current practice and attitudes concerning home-based monitoring (with daily home visits by professionals) and telemonitoring (using devices and the internet for daily self-recorded measurements) in high-risk pregnancies requiring maternal and fetal monitoring in the Netherlands.
This nationwide cross-sectional study involved sending a web-based survey to the obstetrics departments of all 73 hospitals in the Netherlands to be answered by 1 representative dedicated to pregnancy monitoring per hospital. The primary outcome was the provision of home-based monitoring or telemonitoring using cardiotocography between 1995 and 2018. The survey further addressed perspectives regarding the use of home-based monitoring and telemonitoring, including (contra)indications, advantages, and disadvantages for pregnant women and clinicians.
The response rate for the provision of either home-based monitoring or telemonitoring was 100%. In 2018, 38% (28/73) of centers in the Netherlands offered either home-based monitoring or telemonitoring or both to pregnant women with complications. Home-based monitoring was offered in 26% (19/73) of the centers; telemonitoring, in 23% (17/73); and both in 11% (8/73). Telemonitoring was first offered in 2009, increasing from 4% (3/73) of hospitals in 2014 to 23% (17/73) in 2018. Responses were received from 78% (57/73) of the invited hospitals and analyzed. Of all 17 centers using telemonitoring, 59% (10/17) did not investigate perinatal outcomes, safety, and patient satisfaction prior to implementation. Other (6/17, 35%) telemonitoring centers are participating in an ongoing multicenter randomized clinical trial comparing patient safety, satisfaction, and costs of telemonitoring with standard hospital admission. Home-based monitoring and telemonitoring are provided for a wide range of complications, such as fetal growth restriction, pre-eclampsia, and preterm rupture of membranes. The respondents reported advantages of monitoring from home, such as reduced stress and increased rest for patients, and reduction of admission and possible reduction of costs. The stated barriers included lack of insurance reimbursement and possible technical issues.
Home-based monitoring is provided in 26% (19/73) and telemonitoring, in 23% (17/73) of hospitals in the Netherlands to women with pregnancy complications. Altogether, 38% (28/73) of hospitals offer either home-based monitoring or telemonitoring or both as an alternative to hospital admission. Future research is warranted to assess safety and reimbursement issues before more widespread implementation of this practice.
在复杂妊娠中，对胎儿和产妇情况的日常监测会导致频繁的门诊就诊或（延长）住院。替代住院的方法包括专业人员上门的家庭监测或通过孕妇自我测量并上传以供临床评估的远程监测。对于这两种替代方法，都可以在家中进行胎心监护和血压测量。目前尚不清楚这些策略在多大程度上、出于何种原因以及针对哪些妊娠并发症使用。
本研究旨在评估目前荷兰高风险妊娠中需要监测产妇和胎儿的家庭监测（专业人员每日上门）和远程监测（使用设备和互联网进行日常自我记录测量）的实践和态度。
本全国性横断面研究向荷兰所有 73 家医院的产科部门发送了一份在线调查，由每家医院的一名专门负责妊娠监测的代表回答。主要结局是在 1995 年至 2018 年间提供使用胎心监护的家庭监测或远程监测。该调查还涉及对家庭监测和远程监测使用的看法，包括（相对）适应证、对孕妇和临床医生的优缺点。
提供家庭监测或远程监测的应答率为 100%。2018 年，荷兰 38%（28/73）的中心为有并发症的孕妇提供家庭监测或远程监测或两者兼有。26%（19/73）的中心提供家庭监测；23%（17/73）的中心提供远程监测；11%（8/73）的中心同时提供两者。远程监测于 2009 年首次提供，从 2014 年的 4%（3/73）医院增加到 2018 年的 23%（17/73）。邀请了 78%（57/73）的医院回复并进行了分析。在使用远程监测的所有 17 个中心中，59%（10/17）在实施前没有调查围产期结局、安全性和患者满意度。其他（6/17，35%）的远程监测中心正在参与一项正在进行的多中心随机临床试验，比较远程监测与标准住院治疗的患者安全性、满意度和成本。家庭监测和远程监测用于多种并发症，如胎儿生长受限、子痫前期和早产胎膜早破。应答者报告了从家中监测的优势，如减少患者的压力和休息增加，以及减少住院和可能降低成本。报告的障碍包括缺乏保险报销和可能存在技术问题。
荷兰 26%（19/73）的医院为有妊娠并发症的妇女提供家庭监测，23%（17/73）的医院提供远程监测。总共 38%（28/73）的医院提供家庭监测或远程监测或两者作为住院治疗的替代方案。在更广泛地实施这种做法之前，有必要进行安全性和报销问题的研究。
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