Maternal health, antenatal and at 8 weeks after delivery, in home versus in-hospital fetal monitoring in high-risk pregnancies.
OBJECTIVE
To assess maternal health outcome, comparing high-risk pregnant women to either domiciliary monitoring or in-hospital monitoring, and a low risk pregnant group.


METHODS
Paper and pencil questionnaire, distributed antenatal and 8 weeks after the delivery.


METHODS
A university hospital.


METHODS
Three groups: 130 high-risk pregnant women, who entered a randomized clinical trial and were allocated to either home (n=69) or in-hospital monitoring (n=61), and a reference cohort of low risk pregnant women (n=55).


METHODS
Antenatal physical and mental health (RAND36) and social experiences; mode of delivery; complications postpartum; physical health, mental health, and social experiences at 8 weeks postpartum.


RESULTS
In all groups, antenatal physical health was considerably lower compared to the physical health of US women aged 18--44 years. Antenatal mental health was lower in high-risk women than in low-risk women (P<0.05). Antenatal maternal health, the mode of delivery, and maternal complications postpartum did not differ significantly between in-hospital and domiciliary monitored women. Eight weeks after delivery, physical health improved considerably in all groups; mental health was significantly lower in high-risks as compared to low-risk women (P<0.01). The allocated monitoring strategy showed a significant effect on mental health at 8 weeks after delivery; the mental health score being lower in the domiciliary monitored group (P<0.05).


CONCLUSIONS
At 8 weeks after the delivery, physical health improves substantially in all groups. Mental health is higher in low-risks than in high-risks. Within the high-risk group domiciliary and in-hospital monitored women have the same physical maternal outcome at 8 weeks after delivery. However, mental maternal health in in-hospital monitored women at 8 weeks was probably biased by a medicalization effect.
Monincx
W M
WM
Department of Gynaecology and Obstetrics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. stoelmonincx@hotmail.com
Birnie
E
E
Zondervan
H A
HA
Bleker
O P
OP
Bonsel
G J
GJ
D000293:Adolescent; D000328:Adult; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D005323:Fetal Monitoring; D006304:Health Status; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D008429:Maternal Welfare; D008603:Mental Health; D049590:Postpartum Period; D011247:Pregnancy; D011295:Prenatal Care; D011644:Puerperal Disorders; D012307:Risk Factors