Home cardiotocography for high-risk obstetric care: A prospective observational feasibility study
- 1Department of Applied Health Sciences, School of Health Sciences, College of Medicine and Health, University of Birmingham, Birmingham, United Kingdom
- 2Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
Abstract
Home cardiotocography (CTG) may support remote antenatal surveillance, reduce hospital attendances, and improve patient-centred maternity care. However, United Kingdom (UK) evidence remains limited, and international findings may not be generalisable due to differences in maternity pathways and digital implementation. We therefore evaluated the feasibility, acceptability, usability, and safety of home CTG monitoring in a UK cohort of high-risk pregnant women. In this single-centre prospective feasibility study, 50 English-speaking women with high-risk singleton pregnancies at ≥32 weeks’ gestation were enrolled. Participants received a portable CTG device and were advised to complete one hour of home monitoring weekly, for up to six weeks, or until delivery. Recordings were reviewed synchronously. The primary outcome was completion of 20 minutes of continuous, interpretable monitoring per episode. Secondary outcomes included feasibility, anxiety, acceptability, usability, competency, technological issues, and safety. In total, 204 home monitoring sessions were completed. The primary outcome was achieved in 82.4% (95% Confidence interval (CI), 76.5%-87.0%) of sessions (168/204), with a mean continuous monitoring duration of 34.3 ± 16.8 minutes. Session number was not associated with achievement of the primary outcome (Odds Ratio (OR) 1.18, 95% CI 0.93–1.51; p = 0.19) or monitoring duration (p = 0.16). Maternal demographic characteristics showed no statistically significant association with monitoring competency in the exploratory analysis. Anxiety scores decreased significantly following participation (p = 0.0004), including before and after the first (p = 0.01) and fifth sessions (p = 0.007). Usability was rated highly (mean 77.6; grade B + , 80th percentile). Participants were advised to attend maternity triage following 13 sessions (6.4%). No prespecified adverse outcomes related to device use occurred. Overall, 78% would use home CTG instead of hospital attendance in a future pregnancy. Home CTG monitoring for high-risk pregnancies was feasible, acceptable, usable, with no safety concerns identified in this single-arm cohort. These findings support future implementation, pathway integration and development of effectiveness studies. Author summary: In recent years, there have been rapid advancements in digital technology for pregnancy care, enabling monitoring of the fetal heartrate, namely cardiotocography, to be undertaken in the home setting. Evidence for its use within the United Kingdom (UK) is currently limited and literature from other non-UK healthcare settings may not be directly generalisable, due to differences in clinical care pathways and methods of digital implementation. Consequently, we aimed to comprehensively evaluate the use of home CTG in our high-risk pregnant women to understand if it is a feasible, acceptable, usable and without evidence of safety concerns, whilst further understanding if certain patient characteristics influence how well home CTG is performed. After undertaking 204 home monitoring sessions in a cohort of 50 high-risk women, we found that achieving a consistent duration of home CTG monitoring was feasible, whilst further associated with minimal safety and technological concerns. Participants additionally found home CTG highly usable and acceptable. This study supports the integration of home CTG into clinical care pathways and promotes the development of implementation effectiveness trials to better how home CTG can fit into contemporary maternity care.
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BibTeX
@article{vance2026home,
title = {{Home cardiotocography for high-risk obstetric care: A prospective observational feasibility study}},
author = {Jack Le Vance and Victoria Hodgetts Morton and R. Katie Morris and Leo Gurney},
journal = {PLOS Digital Health},
year = {2026},
month = nov,
doi = {10.1371/journal.pdig.0001823},
url = {https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0001823},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Home cardiotocography for high-risk obstetric care: A prospective observational feasibility study
AU - Jack Le Vance
AU - Victoria Hodgetts Morton
AU - R. Katie Morris
AU - Leo Gurney
PY - 2026
DA - 2026/11/06
JO - PLOS Digital Health
DO - 10.1371/journal.pdig.0001823
UR - https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0001823
AB - Home cardiotocography (CTG) may support remote antenatal surveillance, reduce hospital attendances, and improve patient-centred maternity care. However, United Kingdom (UK) evidence remains limited, and international findings may not be generalisable due to differences in maternity pathways and digital implementation. We therefore evaluated the feasibility, acceptability, usability, and safety of home CTG monitoring in a UK cohort of high-risk pregnant women. In this single-centre prospective feasibility study, 50 English-speaking women with high-risk singleton pregnancies at ≥32 weeks’ gestation were enrolled. Participants received a portable CTG device and were advised to complete one hour of home monitoring weekly, for up to six weeks, or until delivery. Recordings were reviewed synchronously. The primary outcome was completion of 20 minutes of continuous, interpretable monitoring per episode. Secondary outcomes included feasibility, anxiety, acceptability, usability, competency, technological issues, and safety. In total, 204 home monitoring sessions were completed. The primary outcome was achieved in 82.4% (95% Confidence interval (CI), 76.5%-87.0%) of sessions (168/204), with a mean continuous monitoring duration of 34.3 ± 16.8 minutes. Session number was not associated with achievement of the primary outcome (Odds Ratio (OR) 1.18, 95% CI 0.93–1.51; p = 0.19) or monitoring duration (p = 0.16). Maternal demographic characteristics showed no statistically significant association with monitoring competency in the exploratory analysis. Anxiety scores decreased significantly following participation (p = 0.0004), including before and after the first (p = 0.01) and fifth sessions (p = 0.007). Usability was rated highly (mean 77.6; grade B + , 80th percentile). Participants were advised to attend maternity triage following 13 sessions (6.4%). No prespecified adverse outcomes related to device use occurred. Overall, 78% would use home CTG instead of hospital attendance in a future pregnancy. Home CTG monitoring for high-risk pregnancies was feasible, acceptable, usable, with no safety concerns identified in this single-arm cohort. These findings support future implementation, pathway integration and development of effectiveness studies. Author summary: In recent years, there have been rapid advancements in digital technology for pregnancy care, enabling monitoring of the fetal heartrate, namely cardiotocography, to be undertaken in the home setting. Evidence for its use within the United Kingdom (UK) is currently limited and literature from other non-UK healthcare settings may not be directly generalisable, due to differences in clinical care pathways and methods of digital implementation. Consequently, we aimed to comprehensively evaluate the use of home CTG in our high-risk pregnant women to understand if it is a feasible, acceptable, usable and without evidence of safety concerns, whilst further understanding if certain patient characteristics influence how well home CTG is performed. After undertaking 204 home monitoring sessions in a cohort of 50 high-risk women, we found that achieving a consistent duration of home CTG monitoring was feasible, whilst further associated with minimal safety and technological concerns. Participants additionally found home CTG highly usable and acceptable. This study supports the integration of home CTG into clinical care pathways and promotes the development of implementation effectiveness trials to better how home CTG can fit into contemporary maternity care.
SN - 2767-3170
ER -