feasibility of remote ectg monitoring home@hospital in complicated pregnancies

Conditions: Pregnancy Related; Remote Monitoring; Feasibility

Summary: the objective of this single center, interventional cohort study is to evaluate the feasibility of remote electrophysiological cardiotocography (ectg) monitoring in complicated pregnancies in a home@hospital setting. the primary objective is to assess: • the success rate of the self-administered ectg measurement the secondary objective is to asses: * maternal and perinatal outcomes * patients wellbeing and satisfaction. * healthcare professionals' (hcps') satisfaction * analysis of antenatal costs participants will: * self-administer remote ectg monitoring once daily during admission (or at least twice weekly at the outpatient clinic) * self-measure their blood pressure, heartrate and temperature * enter the measurements, symptoms and worries into an application on their telephone. * answer questionnaires at 3 moments during the study, assessing their wellbeing and satisfaction of the received care and self-administered remote monitoring device.


Eligibility criteria:
inclusion criteria: in order to be eligible to participate in this study, a subject must meet all of the following criteria: * minimum age of 18 years old * pregnant patients with a gestational age between 32+0 and 36+6 weeks and days * singleton pregnancy * any indication for fetal monitoring at least twice per week (e.g.): * pre-eclampsia (pe) * fetal growth restriction (fgr) * preterm pre-labor rupture of membranes (pprom) * absence of exclusion criteria \> 24 hours after admission. * oral and written informed consent is obtained. exclusion criteria: a potential subject who meets any of the following criteria will be excluded from participation in this study: * an indication for intravenous medication * blood pressure \>160/110 a millimeter of mercury (mmhg) * absent-/or reversed flow umbilical artery doppler * hemolysis elevated liver enzymes and low platelets (hellp) (table 1) * obstetric intervention expected \<48 hours, e.g. due to: * non reassuring cardiotocography (ctg) * active vaginal blood loss * signs of abruption placentae * meconium stained amniotic fluid * signs of chorioamnionitis * patients admitted with a clinical diagnosis of sepsis with hypotension (i.e. septic shock). * insufficient knowledge of dutch or english language * insufficient comprehension of instruction nemo remote® or patient information * fetal and/or maternal cardiac arrhythmias * contraindications to abdominal patch placement (dermatologic diseases of the abdomen precluding preparation of the abdomen with abrasive paper) * patients connected to an external or implanted electrical stimulator, such as transcutaneous electro neuro stimulation (tens) and pacemaker (because of disturbance of the electrophysiological signal).

Keywords: feasibility remote complicated pregnancies antenatal non invasive fetal electrocardiography (ni-fecg) electrophysiological cardiotocography (ectg) high-risk pregnancies pregnancy maternal and fetal monitoring monitoring electrophysiological non invasive preterm pre-labor rupture of membranes (pprom) pre-eclampsia (pe) fetal growth restriction (fgr) home monitoring remote monitoring second trimester self-administered satisfaction