Home cardiotocography for high-risk obstetric care: A prospective observational feasibility study

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.