Hans van den Heuvel is about to begin his gynaecology training and is set to conduct doctoral research into the impact of remote guidance on high-risk pregnancies. Luscii spoke to him about the challenges of his field, the influence of home measurement on his patients, and the mutual cooperation between doctors and nurses.
Your current focus is obstetrics. What sort of things do your patients encounter in daily life?
‘For many of my patients, pregnancy is something they are experiencing for the first time. That in itself is exciting, yet can also be somewhat daunting. If complications are present too, this makes the situation considerably more complex. Inadequate growth, diabetes, blood pressure problems. We also assist women in Utrecht with a congenital heart defect. All these people suffer from uncertainties and have to visit the hospital regularly for check-ups and treatment. That causes stress to daily life. The biggest problems with high-risk pregnancies are therefore usually social in nature. You not only have to offer guidance to the pregnant woman, but also to her loved ones. Emotions must be addressed and dealt with correctly and, as a result, expectation management is very important. As a doctor, you want to offer guidance, but the difficult thing with a complicated pregnancy is that you cannot say much with certainty. The bottom line is that I always strive to outline and explain different scenarios with great patience’.
You are using home measurement with Luscii for pregnancy hypertension. How’s that going?
‘We are all really happy with it. And by we, I also mean my patients. Pregnant women measure their blood pressure at home on a daily basis, and send the results to us via the Luscii app. They also fill in a questionnaire about their general well-being via the app. Home measuring promotes insight into illness. Patients learn what good blood pressure is and recognise the physical signals. That leads to involvement and cooperation. For example, when my patients develop a headache, they measure their blood pressure levels more often by themselves. And when their levels are too high, they call the hospital to discuss. They understand the connection. On top of that, they find it reassuring that someone is always watching. After all, a nurse will make immediate contact if blood pressure levels show an upward trend. In the past, you may not have seen someone for two weeks and were then suddenly confronted with sky-high blood pressure at the outpatient clinic. With the use of Luscii, that hardly happens anymore’.
Does home measurement have an impact on treatment?
‘If you catch it early enough, you can stabilise high blood pressure with tablets, for example with a beta-blocker. But you don’t want the blood pressure to drop too much for the well-being of the baby. In the past, women sometimes had to go to the outpatient clinic several times a week for a check-up. Some were even admitted to monitor their blood pressure. That has become less frequent now women are able to measure blood pressure at home and we can identify hypertension earlier. We are still investigating whether it has a positive effect in large groups too, but I regularly experience a promising impact in practice’.
What are the biggest challenges in gynaecology?
‘The thing that worries me the most is the lack of nurses. You see it everywhere: in the delivery rooms, in the clinical department, the children’s ward. It would help if we appreciated the nursing field more. A higher salary, making the training programme more appealing. I work fairly intensively with specialised nurses and hold them in very high regard. Strangely enough, it is actually through the use of Luscii that I can see how the range of their duties is changing and how they are gaining more control. Nurses used to explain the delivery at the outpatient clinic, but now they are also an important link in the remote monitoring of pregnant women. Nurses are the first point of contact; they respond when blood pressure steps out of line. I think it’s great that gynaecologists share the responsibility of home monitoring with nurses. It strengthens mutual cooperation, and that can only be a good thing’.