Home-telemonitoring of fetal and maternal condition in complicated pregnancies: Results from a real-world cohort to understand unplanned hospital visits and re-admissions

Abstract

BACKGROUND: Telemonitoring in complicated pregnancies involves cardiotocography (CTG), blood pressure, and symptom reporting. Understanding the use of in-hospital care during telemonitoring is essential for effective implementation of hybrid antenatal care models. OBJECTIVE: To evaluate unplanned hospital visits and re-admissions during telemonitoring in complicated pregnancies using a real-world cohort. METHODS: This single-center retrospective cohort study (2017-2023) included patients enrolled in telemonitoring for premature rupture of membranes (PPROM), preeclampsia (PE), fetal growth restriction (FGR), history of fetal demise, congenital anomalies, or recurrent reduced fetal movements. Patients conducted home-based CTG, blood pressure, and temperature monitoring, reviewed real time by obstetric professionals. Primary outcome was the use of in-hospital care categorized by number and reason for unplanned hospital visits and re-admissions. Secondary outcomes included perinatal and neonatal clinical outcomes. RESULTS: A total of 210 women were included in telemonitoring, due to PPROM (13.8%), PE (17.1%), FGR (28.1%), history of fetal demise (5.7%), recurrent reduced fetal movements (20.9%), congenital anomalies (6.7%), and other reasons (7.6%). Median gestational age at telemonitoring initiation was 33 weeks (range 26-39), with a median duration of 11 days (range 1-89). Unplanned hospital visits occurred in 76.2% (160/210), with 335 visits during 2789 monitoring days (12.0%), median of 1.6 visits per patient. Purpose of hospital visits included uninterpretable CTG (34.3%), symptoms of PE, PPROM, or hemorrhage (27.5%), non-reassuring CTG (13.4%), and reduced fetal movements (6.3%). Re-admissions occurred in 38.6% (81/210), most frequently in those with PPROM (51.7%) and PE (50.0%). Re-admission causes included non-reassuring CTG (21.3%), imminent labor (14.3%), severe hypertension (12.2%) antepartum hemorrhage (8.2%), reduced fetal movements (6.1%), maternal distress (5.1%), or other maternal symptoms (32.8%). Seven CTGs (0.25%) led to emergency cesarean sections within 24 h. No maternal severe adverse events or intrauterine deaths occurred during telemonitoring. Five neonatal deaths (2.4%) occurred, none of them were attributable to telemonitoring care. CONCLUSIONS: Telemonitoring of complicated pregnancies resulted in 1-2 unplanned hospital visits per patient on average. These findings reflect expected clinical needs in complicated pregnancies. Re-admissions occurred in 38.6% of patients. No adverse events were attributable to telemonitoring. To further enable hospital at home care, these results provide valuable insights for policymakers and professionals regarding the implementation of telemonitoring in complicated pregnancies. KEY MESSAGE: Telemonitoring in complicated pregnancies led to an average of 1-2 unplanned visits per patient and 38.6% re-admissions, without related adverse events. These findings support provide valuable insight for policymakers and professionals regarding the implementation of telemonitoring in complicated pregnancies.