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01-12-2018 | Maternal-Fetal Medicine

Acceptance of a new non-invasive fetal monitoring system and attitude for telemedicine approaches in obstetrics: a case–control study

Authors: Katharina Schramm, Florian Lapert, Juliane Nees, Carlijn Lempersz, S. Guid Oei, Markus W. Haun, Imad Maatouk, Thomas Bruckner, Christof Sohn, Sarah Schott

Published in: Archives of Gynecology and Obstetrics | Issue 6/2018

Abstract

Purpose

Reduction of maternal morbidity and mortality is a major worldwide objective anchored in the millennium goals of the United Nations. To improve fetal and maternal care, a constant attempt to discover groundbreaking technologies is ongoing. One approach is the enhancement of non-invasive fetal ECG devices. Most importantly, acceptance of new technologies by pregnant women is a prerequisite for successful implementation.

Methods

This questionnaire-based study conducted at the University Hospital Heidelberg, Germany between May and June 2017 evaluates pregnant women’s attitudes towards a new device for fetal ECG monitoring and its potential home usage. The study population was questioned after exposure to the Parides/Atlantis prototype (Nemo Healthcare, Veldhoven, The Netherlands), whereas the maternal and gestational age-matched control group was left to envision telemedical topics.

Results

The prototype and its potential usage in a clinical and telemedical setting was highly accepted, and its comfort and appearance satisfied participants. Its use caused significantly improved telemedical understanding as envision increased (p = 0.0015). Implementation and integration of telemedical devices into antenatal care was significantly preferred by the study group (p = 0.0011), though participants desire more specific features for their personal use. Optional home-based self-monitoring to reduce scheduled doctoral visits (p = 0.0004) as well as self-assessment prior to self-initiated, unscheduled consultation (p < 0.0001) could be affected positively by such a device. Furthermore, it could reduce face-to-face interaction with the care provider (p = 0.0163).

Conclusions

The positive feedback on remote self-monitoring might open options for a more “patient as partners” oriented prenatal care in the future. Safety and reliability remain a major issue. More comprehensive studies with new technologies are needed to diligently ensure quality of care. Finally, results for new technologies must be communicated to pregnant women for their acceptance and usage of new devices.

United Nations (2015) The millenium development goals report 2015. http://mdgs.un.org/unsd/mdg/Resources/Static/Products/Progress2015/English2015.pdf. Accessed 19 November 2017

Alfirevic Z, Devane D, Gyte GML, Cuthbert A (2017) Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.cd006066.pub3 CrossRefPubMed

Devane D, Lalor JG, Daly S, McGuire W, Cuthbert A, Smith V (2017) Cardiotocography versus intermittent auscultation of fetal heart on admission to labour ward for assessment of fetal wellbeing. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.cd005122.pub5 CrossRefPubMed

Balfour HH Jr, Bowe ET, James LS (1971) Scalp abscesses following fetal blood sampling or monitoring. J Pediatr 79(2):344CrossRef

Chawla R, Deppe G, Ahart S, Gleicher N (1984) Hemorrhage after fetal scalp blood sampling. Am J Obstet Gynecol 149(1):92CrossRef

NICE (2014) Intrapartum care for healthy women and babies. NICE guidance CG 190. https://www.nice.org.uk/guidance/cg190. Accessed 25 Sept 2018

Westerhuis MEMH, Moons KGM, van Beek E, Bijvoet SM, Drogtrop AP, van Geijn HP, van Lith JMM, Mol BWJ, Nijhuis JG, Oei SG, Porath MM, Rijnders RJP, Schuitemaker NWE, van der Tweel I, Visser GHA, Willekes C, Kwee A (2007) A randomised clinical trial on cardiotocography plus fetal blood sampling versus cardiotocography plus ST-analysis of the fetal electrocardiogram (STAN^®) for intrapartum monitoring. BMC Pregnancy and Childbirth 7:13. https://doi.org/10.1186/1471-2393-7-13 CrossRefPubMedPubMedCentral

Saccone G, Schuit E, Amer-Wåhlin I, Xodo S, Berghella V (2016) Electrocardiogram st analysis during labor: a systematic review and meta-analysis of randomized controlled trials. Obstet Gynecol 127(1):127–135. https://doi.org/10.1097/aog.0000000000001198 CrossRefPubMed

Potti S, Berghella V (2012) ST waveform analysis versus cardiotocography alone for intrapartum fetal monitoring: a meta-analysis of randomized trials. Am J Perinatol 29(08):657–664. https://doi.org/10.1055/s-0032-1314886 CrossRefPubMed

10.

Olofsson P, Ayres-de-Campos D, Kessler J, Tendal B, Yli BM, Devoe L (2014) A critical appraisal of the evidence for using cardiotocography plus ECG ST interval analysis for fetal surveillance in labor. Part II: the meta-analyses. Acta Obstet Gynecol Scand 93(6):571–586. https://doi.org/10.1111/aogs.12412 CrossRefPubMedPubMedCentral

11.

Belfort MA, Saade GR, Thom E, Blackwell SC, Reddy UM, Thorp JM Jr, Tita AT, Miller RS, Peaceman AM, McKenna DS, Chien EK, Rouse DJ, Gibbs RS, El-Sayed YY, Sorokin Y, Caritis SN, VanDorsten JP, Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network (2015) A randomized trial of intrapartum fetal ECG ST-segment analysis. N Engl J Med 373(7):632–641. https://doi.org/10.1056/NEJMoa1500600 CrossRefPubMedPubMedCentral

12.

Blix E, Brurberg KG, Reierth E, Reinar LM, Øian P (2016) ST waveform analysis versus cardiotocography alone for intrapartum fetal monitoring: a systematic review and meta-analysis of randomized trials. Acta Obstet Gynecol Scand 95(1):16–27. https://doi.org/10.1111/aogs.12828 CrossRefPubMed

13.

Neilson JP (2015) Fetal electrocardiogram (ECG) for fetal monitoring during labour. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.cd000116.pub5 CrossRefPubMed

14.

Hatzmann WSS, Reinhard J (2010) Die nicht-invasive Ableitung des fetalen EKGs—Eine neue Möglichkeit der Überwachung der fetalen Herzfrequenz mit dem Monica AN24 TM. Frauenarzt 51:120–123

15.

Sanger N, Hayes-Gill BR, Schiermeier S, Hatzmann W, Yuan J, Herrmann E, Louwen F, Reinhard J (2012) Prenatal foetal non-invasive ECG instead of doppler CTG—a better alternative? Geburtshilfe Frauenheilkd 72(7):630–633. https://doi.org/10.1055/s-0032-1315012 CrossRefPubMedPubMedCentral

16.

Dashe JS, McIntire DD, Twickler DM (2009) Maternal obesity limits the ultrasound evaluation of fetal anatomy. J Ultrasound Med 28(8):1025–1030. https://doi.org/10.7863/jum.2009.28.8.1025 CrossRefPubMed

17.

Ray A, Hildreth A, Esen UI (2008) Morbid obesity and intra-partum care. J Obstet Gynaecol 28(3):301–304. https://doi.org/10.1080/01443610802042548 CrossRefPubMed

18.

Alexander S, Blondel B, Bouvier-Colle M, Dattani N, Delnord M, Gissler M, Macfarlane A, Mohangoo A, Van der Pal K, Szamotulska K, Zeitlin J, Zhang W (2013) European perinatal health report. health and care of pregnant women and babies in Europe in 2010. Euro-peristat. http://www.europeristat.com/images/doc/EPHR2010_w_disclaimer.pdf. Accessed 01 November 2017

19.

Appelboom G, Camacho E, Abraham ME, Bruce SS, Dumont EL, Zacharia BE, D’Amico R, Slomian J, Reginster JY, Bruyere O, Connolly ES Jr (2014) Smart wearable body sensors for patient self-assessment and monitoring. Arch Public Health 72(1):28. https://doi.org/10.1186/2049-3258-72-28 CrossRefPubMedPubMedCentral

20.

Hassol A, Walker JM, Kidder D, Rokita K, Young D, Pierdon S, Deitz D, Kuck S, Ortiz E (2004) Patient experiences and attitudes about access to a patient electronic health care record and linked web messaging. J Am Med Inform Assoc 11(6):505–513. https://doi.org/10.1197/jamia.M1593 CrossRefPubMedPubMedCentral

21.

McGillicuddy JW, Weiland AK, Frenzel RM, Mueller M, Brunner-Jackson BM, Taber DJ, Baliga PK, Treiber FA (2013) Patient attitudes toward mobile phone-based health monitoring: questionnaire study among kidney transplant recipients. J Med Internet Res 15(1):e6. https://doi.org/10.2196/jmir.2284 CrossRefPubMedPubMedCentral

22.

Patel V, Hale TM, Palakodeti S, Kvedar JC, Jethwani K (2015) Prescription tablets in the digital age: a cross-sectional study exploring patient and physician attitudes toward the use of tablets for clinic-based personalized health care information exchange. JMIR Res Protoc 4(4):e116. https://doi.org/10.2196/resprot.3806 CrossRefPubMedPubMedCentral

23.

Gandek B, Ware JE, Aaronson NK, Apolone G, Bjorner JB, Brazier JE, Bullinger M, Kaasa S, Leplege A, Prieto L, Sullivan M (1998) Cross-validation of item selection and scoring for the SF-12 health survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol 51(11):1171–1178CrossRef

24.

Krieger T, Zimmermann J, Huffziger S, Ubl B, Diener C, Kuehner C, Grosse Holtforth M (2014) Measuring depression with a well-being index: further evidence for the validity of the WHO Well-Being Index (WHO-5) as a measure of the severity of depression. J Affect Disord 156:240–244. https://doi.org/10.1016/j.jad.2013.12.015 CrossRefPubMed

25.

Huizink AC, Delforterie MJ, Scheinin NM, Tolvanen M, Karlsson L, Karlsson H (2016) Adaption of pregnancy anxiety questionnaire-revised for all pregnant women regardless of parity: PRAQ-R2. Arch Womens Ment Health 19(1):125–132. https://doi.org/10.1007/s00737-015-0531-2 CrossRefPubMed

26.

Melender HL (2002) Experiences of fears associated with pregnancy and childbirth: a study of 329 pregnant women. Birth 29(2):101–111CrossRef

27.

Löwe B, Spitzer RL, Zipfel S, Herzog W (2002) Gesundheitsfragebogen für Patienten (PHQ D). Komplettversion und Kurzform. Testmappe mit Manual, Fragebögen, Schablonen, 2nd edn. Pfizer, Karlsruhe

28.

Lazaridis A, Lees CC (2016) Adjunctive use of intrapartum foetal ST-segment analysis (STAN) confers no benefit over conventional foetal heart rate monitoring. Evid Based Med 21(3):105–106. https://doi.org/10.1136/ebmed-2015-110304 CrossRefPubMed

29.

Stout MJ, Cahill AG (2011) Electronic fetal monitoring: past, present, and future. Clin Perinatol 38(1):127–142. https://doi.org/10.1016/j.clp.2010.12.002 CrossRefPubMed

30.

Rüttgers H, Meyer-Menk W, Stagel A, Spangler W, Kubli F (1974) Instantane fetale Herzfrequenzregistrierung über das abdominale EKG. Gynäkologisch-geburtshilfliche Rundschau 14:79–80CrossRef

31.

Berger C, Baumann U, Ramzin M, Richter R (1978) Wertigkeit des transabdominal registrierten fetalen elektrokardiogramms für die kardiotokographie. Zeitschrift für Geburtshilfe und Perinatologie 182:278PubMed

32.

Sameni R, Clifford GD (2010) A review of fetal ECG signal processing; issues and promising directions. Open Pacing, Electrophysiol Ther J 3:4–20. https://doi.org/10.2174/1876536X01003010004 CrossRef

33.

Vullings R, Verdurmen KMJ, Hulsenboom ADJ, Scheffer S, de Lau H, Kwee A, Wijn PFF, Amer-Wåhlin I, van Laar JOEH, Oei SG (2017) The electrical heart axis and ST events in fetal monitoring: a post hoc analysis following a multicentre randomised controlled trial. PLoS One 12(4):e0175823. https://doi.org/10.1371/journal.pone.0175823 CrossRefPubMedPubMedCentral

34.

Kerner R, Yogev Y, Belkin A, Ben-Haroush A, Zeevi B, Hod M (2004) Maternal self-administered fetal heart rate monitoring and transmission from home in high-risk pregnancies. Int J Gynaecol Obstet 84(1):33–39CrossRef

35.

Hod M, Kerner R (2003) Telemedicine for antenatal surveillance of high-risk pregnancies with ambulatory and home fetal heart rate monitoring–an update. J Perinat Med 31(3):195–200. https://doi.org/10.1515/JPM.2003.026 CrossRefPubMed

36.

Boatin AA, Wylie B, Goldfarb I, Azevedo R, Pittel E, Ng C, Haberer J (2015) Wireless fetal heart rate monitoring in inpatient full-term pregnant women: testing functionality and acceptability. PLoS One 10(1):e0117043. https://doi.org/10.1371/journal.pone.0117043 CrossRefPubMedPubMedCentral

37.

Pomey M-P, Ghadiri DP, Karazivan P, Fernandez N, Clavel N (2015) Patients as partners: a qualitative study of patients’ engagement in their health care. PLoS One 10(4):e0122499. https://doi.org/10.1371/journal.pone.0122499 CrossRefPubMedPubMedCentral

38.

Kilfoyle KA, Vrees R, Raker CA, Matteson KA (2017) Nonurgent and urgent emergency department use during pregnancy: an observational study. Am J Obstet Gynecol 216(2):e181–e187. https://doi.org/10.1016/j.ajog.2016.10.013 CrossRef

39.

Hoyme UB (2016) Pragmatic prevention of preterm birth and evidence based medicine. Arch Gynecol Obstet 294(1):1–3. https://doi.org/10.1007/s00404-016-4094-x CrossRefPubMed

40.

O’Donnell BE, Lewkowitz AK, Vargas JE, Zlatnik MG (2016) Examining pregnancy-specific smartphone applications: what are patients being told? J Perinatol. https://doi.org/10.1038/jp.2016.77 CrossRefPubMed

41.

Goetz M, Muller M, Matthies LM, Hansen J, Doster A, Szabo A, Pauluschke-Frohlich J, Abele H, Sohn C, Wallwiener M, Wallwiener S (2017) Perceptions of patient engagement applications during pregnancy: a qualitative assessment of the patient’s perspective. JMIR mHealth uHealth 5(5):e73. https://doi.org/10.2196/mhealth.7040 CrossRefPubMedPubMedCentral

42.

Standoli CE, Guarneri MR, Perego P, Mazzola M, Mazzola A, Andreoni G (2016) A smart wearable sensor system for counter-fighting overweight in teenagers. Sensors 16(8):1220. https://doi.org/10.3390/s16081220 CrossRef

Title: Acceptance of a new non-invasive fetal monitoring system and attitude for telemedicine approaches in obstetrics: a case–control study
Authors: Katharina Schramm
Florian Lapert
Juliane Nees
Carlijn Lempersz
S. Guid Oei
Markus W. Haun
Imad Maatouk
Thomas Bruckner
Christof Sohn
Sarah Schott
Publication date: 01-12-2018
Publisher: Springer Berlin Heidelberg
Published in: Archives of Gynecology and Obstetrics / Issue 6/2018
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-018-4918-y

At a glance: The STEP trials

Springer Medicine

Acceptance of a new non-invasive fetal monitoring system and attitude for telemedicine approaches in obstetrics: a case–control study

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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