Patient perspectives on telemonitoring in low- and high-risk pregnancies: A feasibility study using a wireless fetal heart rate monitor

OBJECTIVE: Fetal heart rate monitoring is used to assess fetal well-being during pregnancy. In complicated pregnancies, home telemonitoring of pregnant women using cardiotocography has been shown as a promising, safe alternative to hospital admission. For successful integration of digital health into obstetric care for monitoring fetal and maternal well-being, it is essential to focus on the evaluation of patient experience, alongside assessing the feasibility of available telemonitoring technologies. This study aims to investigate user experiences of a fetal heart rate monitor for future use of pregnancy telemonitoring and its feasibility.

STUDY DESIGN: This prospective cohort included low - and high-risk pregnant women with gestational ages between 24 and 37 weeks. The low-risk cohort comprised uncomplicated singleton pregnancies. In the high-risk cohort, singleton pregnancies with various complications requiring daily fetal surveillance such as preterm pre-labor rupture of membranes, pre-eclampsia, fetal growth restriction, or antenatal haemorrhage were included. Participants received a fetal heart rate telemonitoring device for a 14-day period and were instructed to perform 20-minute-long recordings. These were real-time reviewed by a midwife or medical doctor. Primary outcome was users' experience. This was evaluated using the System Usability Scale (SUS), the collected scores are transformed into a percentile rank (0-100) with an associated letter grade (A to F), with A being the highest usability score. Additionally, the self-developed Telemonitoring Survey was used. Secondary outcome measure was feasibility, defined by three components: (1) functionality (capability to record a 20-minute or longer fetal heart rate (FHR) trace), (2) Signal Loss Ratio (calculated as the ratio between the recording duration and periods of unregistered FHR) and (3) interpretability (the capability to identify FHR monitoring features, including baseline, variability, accelerations, and decelerations).

RESULTS: The low-risk and high-risk groups each comprised 30 participants, with a median gestational age of 33.6 weeks (range 24.1-37.7) and 31.9 weeks (range 26.0-36.7), respectively. The system received a grade C on the SUS, with a mean score of 70.7 (range 52.5-95), indicating acceptable usability. The majority of participants reported satisfaction with the system. However, search time and signal loss were mentioned as barriers, causing frustration and insecurity while locating the fetal heartbeat. A total of 173 home-recorded traces in the low-risk group and 85 self-recorded traces (during hospital admission) in the high-risk group were collected, with a median duration of 21.8 min (range 2.2-43.6) and 20.5 min (range 5.3-40.5), respectively. All participants recorded traces of at least 20 min. The median signal loss ratio was 19.4 % in the low-risk group and 17.1 % in the high-risk group. Interpretable measurements were obtained in 95.1 % and 91,8% of traces in respectively.

CONCLUSIONS: The use of a wireless fetal heart rate monitor for self-monitoring in both low- and high-risk pregnancies was associated with high user satisfaction and acceptable usability. Despite some barriers such as search time and signal loss, most participants were able to obtain interpretable traces of adequate duration. These findings support the feasibility of self-administered fetal monitoring in both home and clinical settings, highlighting its potential role for remote monitoring in pregnancies.