Remote monitoring of high-risk pregnancies shown to be safe and cost-effective

Home management of intermediate- and high-risk pregnancies with remote self-monitoring is feasible, safe and cost-effective, according to a recent study.

Aarhus University Hospital in Denmark has been using home management since 2011 as an alternative to hospitalization or frequent outpatient clinic visits, Anne Rahbek Zizzo, MD, PhD, of the hospital’s department of obstetrics and gynecology, and colleagues said in the study.

How home management worked

The study examined 400 singleton pregnant women enrolled in the program between February 2011 and December 2019. Participants included 85 women with preterm premature rupture of membranes (PPROM), 94 women with fetal growth restriction (FGR) or preeclampsia (PE) or both, and 221 women at high risk for PE and pregestational/gestational diabetes or other indications.

Participants with PPROM used equipment provided by the program to monitor their C-reactive protein, temperature, blood pressure and heart rate. They also used cardiotocography to perform nonstress tests. Additionally, women completed questionnaires about abdominal pain, contractions, fetal movements and general maternal well-being.

Every other week, the women were offered outpatient assessments in the clinic including ultrasound scans of estimated fetal weight and amniotic fluid volume, as well as tests for leukocytes in urine and white blood cell counts.

Women experiencing FGR, PE, a high risk for PE and other conditions assessed themselves based on their individual clinical conditions, including blood pressure, a proteinuria test, cardiotocography and a questionnaire on fetal movements, PE symptoms and maternal well-being.

A mobile device using the OpenTele telehealth platform transmitted these data to the hospital, and health care professionals evaluated this information daily. Women who presented non-reassuring data were invited to the hospital for assessment. They were encouraged to contact the hospital day or night with any concerns.

Key study findings

The pregnancies complicated by PPROM saw a 78% (18/23) survival rate before gestational age (GA) 24 plus 0 weeks and a 97% rate (60/62) after GA 23 plus 6 weeks. There were no cases of intrauterine death, delivery, prolapse of umbilical cord or severe chorioamnionitis at home.

Two fetuses in the group of women with PE and FGR died. One had major malformations and hydrops fetalis at GA 34 plus 5 weeks, and the other had severe FGR from week 20 and a 635 g birthweight at GA 28 plus5 weeks. There were no intrauterine deaths or eclampsia cases at home.

There were no major complications in the group of women who had high risk of PE and pregestational or gestational diabetes mellitus or other indications, nor were there any intrauterine deaths or neonatal deaths.

Participants performed an average of six to 13 monitoring sessions each, and 73 of them (18.3%) were readmitted during the program. The participants in the PPROM group and the group at high risk for PE saw the highest risks of readmission (27% and 19%, respectively).

According to the researchers, the participants experienced less anxiety and more freedom with home monitoring than they would have experienced with conventional care. Also, these women said that avoiding long admissions to the hospital was valuable.

The participants further said that they felt it was important to be involved in their treatment and that they had better opportunities for contacting health care professionals while they were at home than they did during admission.

Even among the high-risk participants, the researchers said, many still preferred home monitoring because it was less stressful. These participants also found meaning and value in being together with family and relatives as they processed grief and sorrow, instead of being isolated in the hospital.

Noting a report by the Danish Ministry of Health, the researchers said national implementation of their program could save DKK 18 million in a 5-year period, as more than 1,500 days of hospitalization were spared in the PPROM group and more than 4,200 days of hospitalization were spared by the other groups.

The researchers concluded that home management of pregnant women at intermediate and high risk via remote self-monitoring is feasible and beneficial in terms of maternal and fetal safety.