A 24-hour ambulatory blood pressure monitoring system for preeclampsia management in antenatal care

Pre-eclampsia in low and middle-income settings: What are the barriers to improving perinatal outcomes and evidence-based recommendations?

OBJECTIVE

To discuss the points that still challenge low- and middle-income countries (LMICs) and strategies that have been studied to help them overcome these issues.

METHODS

Narrative review addressing 20 years of articles concerning pre-eclampsia morbidity and mortality in LMICs. We summarized evidence-based strategies to overcome the challenges in order to reduce the pre-eclampsia impact on perinatal outcomes.

RESULTS

Pre-eclampsia is the first or second leading cause in the ranking of avoidable causes of maternal death, and approximately 16% of all maternal deaths are attributable to eclampsia and pre-eclampsia. Considering the social and economic contexts, it represents a major public health concern, and prevention and early detection of pre-eclampsia seem to be a major challenge. Reducing maternal mortality related to hypertensive disturbances depends on public policies to manage these preventable conditions. Early and continuous recognition of signs of severity related to hypertensive disorders during pregnancy and childbirth, self-monitoring of symptoms and blood pressure, as well as preventive approaches such as aspirin and calcium, and magnesium sulfate, are lifesaving procedures that have not yet reached a universal scale.

CONCLUSION

This review provides a vision of relevant points to support pregnant women in overcoming the constraints to healthcare access in LMICs, and strategies that can be applied in primary prenatal care units.

Internet of Things in Pregnancy Care Coordination and Management: A Systematic Review

The Internet of Things (IoT) has positioned itself globally as a dominant force in the technology sector. IoT, a technology based on interconnected devices, has found applications in various research areas, including healthcare. Embedded devices and wearable technologies powered by IoT have been shown to be effective in patient monitoring and management systems, with a particular focus on pregnant women. This study provides a comprehensive systematic review of the literature on IoT architectures, systems, models and devices used to monitor and manage complications during pregnancy, postpartum and neonatal care. The study identifies emerging research trends and highlights existing research challenges and gaps, offering insights to improve the well-being of pregnant women at a critical moment in their lives. The literature review and discussions presented here serve as valuable resources for stakeholders in this field and pave the way for new and effective paradigms. Additionally, we outline a future research scope discussion for the benefit of researchers and healthcare professionals.

Agile Methodologies Applied to the Development of Internet of Things (IoT)-Based Systems: A Review

Throughout the evolution of software systems, empirical methodologies have been used in their development process, even in the Internet of Things (IoT) paradigm, to develop IoT-based systems (IoTS). In this paper, we review the fundamentals included in the manifesto for agile software development, especially in the Scrum methodology, to determine its use and role in IoTS development. Initially, 4303 documents were retrieved, a number that was reduced to 186 after applying automatic filters and by the relevance of their titles. After analysing their contents, only 60 documents were considered. Of these, 38 documents present the development of an IoTS using some methodology, 8 present methodologies focused on the construction of IoTS software, and 14 present methodologies close to the systems life cycle (SLC). Finally, only one methodology can be considered SLC-compliant. Out of 38 papers presenting the development of some IoTS following a methodology for traditional information systems (ISs), 42.1% have used Scrum as the only methodology, while 10.5% have used Scrum combined with other methodologies, such as eXtreme Programming (XP), Kanban and Rapid Prototyping. In the analysis presented herein, the existing methodologies for developing IoTSs have been grouped according to the different approaches on which they are based, such as agile, modelling, and service oriented. This study also analyses whether the different proposals consider the standard stages of the development process or not: planning and requirements gathering, solution analysis, solution design, solution coding and unit testing (construction), integration and testing (implementation), and operation and maintenance. In addition, we include a review of the automated frameworks, platforms, and tools used in the methodologies analysed to improve the development of IoTSs and the design of their underlying architectures. To conclude, the main contribution of this work is a review for IoTS researchers and developers regarding existing methodologies, frameworks, platforms, tools, and guidelines for the development of IoTSs, with a deep analysis framed within international standards dictated for this purpose.

Exploring digital health interventions for pregnant women at high risk for pre-eclampsia and eclampsia in low-income and-middle-income countries: a scoping review

OBJECTIVE

To explore digital health interventions that have been used to support pregnant women at high risk for pre-eclampsia/eclampsia (HRPE/E) in low-income and middle-income countries (LMICs).

DESIGN

Scoping review.

DATA SOURCE

EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL were searched between 1 January 2000 and 20 October 2020.

ELIGIBILITY CRITERIA

The review included original research studies that were published in English, involved pregnant women at HRPE/E and implemented digital health interventions for PE/E in LMICs.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently completed the data extraction for each of the 19 final articles. An inductive approach was used to thematically organise and summarise the results from the included articles.

RESULTS

A total of 19 publications describing 7 unique studies and 9 different digital health interventions were included. Most studies were conducted in South Asia and sub-Saharan Africa (n=16). Of nine unique digital health interventions, two served the purpose of predicting risk for adverse maternal health outcomes while seven focused on monitoring high-risk pregnant women for PE/E. Both of these purposes used mobile phone applications as interface to facilitate data collection, decision making, and communication between health workers and pregnant women. The review identified key functions of interventions including data collection, prediction of adverse maternal outcomes, integrated diagnostic and clinical decision support, and personal health tracking. The review reported three major outcomes: maternal health outcomes including maternal and neonatal morbidity and mortality (n=4); usability and acceptability including ease-of-use, and perceived usefulness, (n=5); and intervention feasibility and fidelity including accuracy of device, and intervention implementation (n=7).

CONCLUSION

Although the current evidence base shows some potential for the use of digital health interventions for PE/E, more prospective experimental and longitudinal studies are needed prior to recommending the use of digital health interventions for PE/E.