Digital health in obstetric care

Around 10% of pregnancies in the Netherlands are complicated by different obstetric complications. Follow up of these pregnancies need extra surveillance with weekly visits or antenatal hospital admission. This thesis describes the use of digital health in pregnancy to replace hospital care to home care for antenatal follow up of complicated pregnancies. Hypertension in pregnancy is increasingly common, and an important cause of maternal and neonatal morbidity and mortality, at short as well as long term. Frequent monitoring of blood pressure (BP), fetal growth, blood and urine during pregnancy is recommended to early identify and monitor hypertensive disease. Interfering with daily life, (un)planned visits and hospitalization pose a substantial burden to patients and care resources. From our SAFE@HOME studies, we found that telemonitoring of blood pressure and symptoms can be of added value in antenatal care. We developed a digital care platform for daily monitoring of home-measurements. In case of good test results, there is no need for (unplanned) hospital visits. In care of a rise in blood pressure, extra visits can be planned. Telemonitoring was associated with a decrease in health care consumption (visits, ultrasounds and hypertension-related hospital admission), without negative effects on maternal and neonatal outcomes. Moreover, home blood pressure monitoring gave pregnant women more insight into their own health and helped (shared) decision making in pregnancy care. In the second part of the thesis, our research focused on pregnant women with established complications requiring daily fetal and maternal monitoring. To compare standard hospital admission with telemonitoring of cardiotocography and blood pressure from home, we performed different studies in order to increase knowledge of this use of digital health for complicated pregnancies. From our work, fetal telemonitoring is feasible for use in the Netherlands. The results from this thesis suggest that use of digital health in pregnancy has the potential to profoundly change antenatal care.