Home telemonitoring in high‐risk pregnancies: A Finnish retrospective cohort study

INTRODUCTION: High-risk pregnancies require close monitoring and frequent hospital visits. Home telemonitoring offers a potential alternative to improve access and satisfaction while reducing healthcare use. This retrospective cohort study characterized the clinical course and events during home telemonitoring including home-based cardiotocography during a pilot program for women with high-risk pregnancies at an urban tertiary hospital. MATERIAL AND METHODS: This retrospective three-year cohort study included 117 singleton pregnancies enrolled in a home telemonitoring program at Helsinki University Hospital between January 2021 and December 2023. Participants were grouped by primary indication: premature rupture of membranes, preeclampsia and/or fetal growth restriction, or other high-risk conditions. The main outcomes included the course and duration of home telemonitoring, rates of hospital visits and readmissions, the onset of labor or emergency cesarean delivery, and severe complications during home telemonitoring, including maternal or fetal death, placental abruption, prolapse of umbilical cord, placenta previa with bleeding, chorioamnionitis, eclampsia, and worsening of preeclampsia. RESULTS: The median gestational age at initiation of home telemonitoring was 32.4 weeks, and the median monitoring duration was 7 days (IQR 2.5-13.5). Thirty-eight women (32.6%) were readmitted. The median gestational age at delivery was 34.6 (range 25.1-41.4) weeks, and 87.2% (102/117) delivered preterm. The overall cesarean rate was 47.0% (55/117). Spontaneous onset of labor occurred in 11 (9.4%) women during the home telemonitoring period; no home deliveries were recorded. 38 women (32.5%) underwent an emergency cesarean delivery. No maternal or intrauterine fetal deaths occurred. Complications occurred in 36 cases (30.8%). The most common complications were chorioamnionitis (n = 21,17.9%) and worsening of preeclampsia (n = 11, 9.4%). No eclampsia was observed. Two cases of placental abruption (n = 2, 1.7%) and two cases of bleeding due to placenta previa (n = 2, 1.7%) occurred. In all the preceding cases, immediate readmission and prompt management resulted in favorable maternal and neonatal outcomes. CONCLUSIONS: This pilot study suggests that home telemonitoring represents an acceptable approach for the management of selected high-risk pregnancies. However, careful patient selection and strict adherence to evidence-based clinical protocols are essential to ensure safe and effective implementation.