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Güneş Öztürk G, Akyıldız D, Karaçam Z. The impact of telehealth applications on pregnancy outcomes and costs in high-risk pregnancy: A systematic review and meta-analysis. J Telemed Telecare 2024; 30:607-630. [PMID: 35570738 DOI: 10.1177/1357633x221087867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Telehealth is an applicable, acceptable, cost-effective, easily accessible, and speedy method for pregnant women. This study aimed to examine the impact of telehealth applications on pregnancy outcomes and costs in high-risk pregnancies. METHODS Studies were selected from PubMed, Science Direct, Web of Science, EBSCO, Scopus, and Clinical Key databases according to the inclusion and exclusion criteria from January to February 2021. Cochrane risk-of-bias tools were used in the quality assessment of the studies. RESULTS Four observational and eight randomized controlled studies were included in this meta-analysis (telehealth: 135,875, control: 94,275). It was seen that the number of ultrasound (p < 0.01) and face-to-face visits (p < 0.01), fasting insulin (p < 0.01), hemoglobin A1C before delivery (p < 0.01), and emergency cesarean section rates (p = 0.05) were lower in the telehealth group. In the telehealth group, the women's use of antenatal corticosteroids (p = 0.03) and hypoglycemic medication at delivery (p = 0.03), the total of nursing interventions (p < 0.01), compliance with actual blood glucose measurements (p < 0.01), induction intervention at delivery (p = 0.003), and maternal mortality (p < 0.001) rates were higher. Two groups were similar in terms of the use of medical therapy, total gestational weight gain, health problems related to pregnancy, mode and complications of delivery, maternal intensive care unit admission, fetal-neonatal growth and development, neonatal health problems and mortality, follow-up, and care costs. DISCUSSION Telehealth and routine care yielded similar maternal/neonatal health and cost outcomes. It can be said that telehealth is a safe technique to work with in the management of high-risk pregnancies.
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Affiliation(s)
- Gizem Güneş Öztürk
- Division of Midwifery, Faculty of Health Science, Aydın Adnan Menderes University, Aydın, Turkey
| | - Deniz Akyıldız
- Division of Midwifery, Faculty of Health Science, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Zekiye Karaçam
- Division of Midwifery, Faculty of Health Science, Aydın Adnan Menderes University, Aydın, Turkey
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Martin JK, Price-Haywood EG, Gastanaduy MM, Fort DG, Ford MK, Peterson SP, Biggio JR. Unexpected Term Neonatal Intensive Care Unit Admissions and a Potential Role for Centralized Remote Fetal Monitoring. Am J Perinatol 2023; 40:297-304. [PMID: 33882588 DOI: 10.1055/s-0041-1727214] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Centralized remote fetal monitoring (CRFM) has been proposed as a method to improve the performance of intrapartum fetal heart rate (FHR) monitoring and perinatal outcomes. The purpose of this study is to determine whether CRFM was associated with a reduction in unexpected term neonatal intensive care unit (NICU) admissions. STUDY DESIGN A pre-post design was used to examine the effectiveness of CRFM which was implemented in stages across five hospitals. The exposure group was all women who underwent intrapartum monitoring via CRFM. The unexposed group was of women who delivered at the same hospitals prior to implementation of CRFM. Pregnancies with expected NICU admissions, gestational age <37 weeks, birth weight <2,500 g, or major fetal anomalies detected prenatally were excluded. The primary outcome was unexpected term NICU admission; secondary outcomes were cesarean and operative vaginal delivery (OVD), and 5-minute Apgar's score of <7 rates. Maternal and delivery characteristics were examined with Student's t, Wilcoxon's, Chi-square, and Fisher's exact tests. Multivariable logistic regression was performed to control for potential confounders. RESULTS There were 19,392 live births included in this analysis. In the univariable analysis, the odds of unexpected term NICU admission was lower among the CRFM exposed group compared with the unexposed group (odds ratio [OR] = 0.86, 95% confidence interval [CI]: 0.75-0.99; p = 0.038). In multivariable analysis, this did not reach statistical significance (OR = 0.92, 95% CI: 0.79-1.06; p = 0.24). Cesarean and OVD were less likely in the exposed group (OR = 0.91, 95% CI: 0.85-0.97; p = 0.008) and (OR = 0.70, 95% CI: 0.59-0.83, p < 0.001), respectively, in univariable analysis. When adjusted for potential confounders, the effect remained statistically significant for cesarean delivery (OR = 0.92, 95% CI: 0.85-0.98; p = 0.012). When adjusted for hospital, OVD rate was lower at the highest volume and highest acuity site (OR = 0.48, 95% CI: 0.36-0.65, p < 0.001). CONCLUSION In some practice settings, utilization of a CRFM system may decrease the risk of unexpected term NICU admission, cesarean, and OVD rate. KEY POINTS · CRFM may decrease unexpected term NICU admissions in some clinical settings.. · CRFM may decrease cesarean delivery rates in some clinical settings.. · CRFM may decrease OVD rates in some clinical settings..
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Affiliation(s)
- Jane K Martin
- Section of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Women's Service Line, Ochsner Health, New Orleans, Louisiana
| | - Eboni G Price-Haywood
- Ochsner Center for Outcomes and Health Services Research, New Orleans, Louisiana.,University of Queensland, Ochsner Clinical School, New Orleans, Louisiana
| | | | - Daniel G Fort
- Ochsner Center for Outcomes and Health Services Research, New Orleans, Louisiana
| | - Mary K Ford
- Section of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Women's Service Line, Ochsner Health, New Orleans, Louisiana
| | - Sydney P Peterson
- Section of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Women's Service Line, Ochsner Health, New Orleans, Louisiana
| | - Joseph R Biggio
- Section of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Women's Service Line, Ochsner Health, New Orleans, Louisiana.,University of Queensland, Ochsner Clinical School, New Orleans, Louisiana
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Gyselaers W, Lanssens D, Perry H, Khalil A. Mobile Health Applications for Prenatal Assessment and Monitoring. Curr Pharm Des 2020; 25:615-623. [PMID: 30894100 DOI: 10.2174/1381612825666190320140659] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/18/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND A mobile health application is an exciting, fast-paced domain that is likely to improve prenatal care. METHODS In this narrative review, we summarise the use of mobile health applications in this setting with a special emphasis on both the benefits of remote monitoring devices and the potential pitfalls of their use, highlighting the need for robust regulations and guidelines before their widespread introduction into prenatal care. RESULTS Remote monitoring devices for four areas of prenatal care are reported: (1) cardio-tocography; (2) blood glucose levels; (3) blood pressure; and (4) prenatal ultrasound. The majority of publications are pilot projects on remote consultation, education, coaching, screening, monitoring and selective booking, mostly reporting potential medical and/or economic benefits by mobile health applications over conventional care for very specific situations, indications and locations, but not always generalizable. CONCLUSIONS Despite the potential advantages of these devices, some caution must be taken when implementing this technology into routine daily practice. To date, the majority of published research on mobile health in the prenatal setting consists of observational studies and there is a need for high-quality randomized controlled trials to confirm the reported clinical and economic benefits as well as the safety of this technology. There is also a need for guidance and governance on the development and validation of new apps and devices and for the implementation of mobile health technology into healthcare systems in both high and low-income settings. Finally, digital communication technologies offer perspectives towards exploration and development of the very new domain of tele-pharmacology.
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Affiliation(s)
- Wilfried Gyselaers
- Department of Obstetrics, Ziekenhuis Oost-Limburg, Genk, Belgium; 2Department of Physiology, Hasselt University, Hasselt, Belgium.,Department of Physiology, Hasselt University, Hasselt, Belgium
| | - Dorien Lanssens
- Department of Physiology, Hasselt University, Hasselt, Belgium.,Mobile Health Unit, Facultiy of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Helen Perry
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, United Kingdom.,Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, United Kingdom
| | - Asma Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, United Kingdom.,Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, United Kingdom
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Peng J, Huang Y, Yu K, Fan R, Zhou J. Maternal health care wearing equipment based on fetal information monitoring. J Infect Public Health 2019; 13:2009-2013. [PMID: 31431419 DOI: 10.1016/j.jiph.2019.07.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 07/23/2019] [Accepted: 07/30/2019] [Indexed: 11/28/2022] Open
Abstract
In order to monitor the fetal information in real time and ensure the health of the pregnant women themselves and their fetuses during pregnancy, a kind of health wearing equipment, abdominal care belt is designed in this study, which can be worn by pregnant women and can be monitored by modern mobile medical APP, and verifies the related performance of the design through a series of experiments. The results show that the safety, practicability and aesthetics of the abdominal care belt designed in this study are all up to the standard. Therefore, the abdominal care belt designed in this study is a relatively successful product, which is expected to be applied in the future and enter the market, so that pregnant women during pregnancy can be more relaxed and convenient.
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Affiliation(s)
- Junyan Peng
- Department of Equipment, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yicheng Huang
- Department of Asset Management, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Kanbin Yu
- Purchasing Center, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200090, China
| | - Renjie Fan
- Purchasing Center, Gongli Hospital Affiliated to the Second Military Medical University, Shanghai 200135, China
| | - Jia Zhou
- Department of Medical Equipment, Shanghai Pulmonary Hospital Affiliated to Tongji University, Shanghai, 200433,China.
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Zhu XH, Tao J, Jiang LY, Zhang ZF. Role of Usual Healthcare Combined with Telemedicine in the Management of High-Risk Pregnancy in Hangzhou, China. JOURNAL OF HEALTHCARE ENGINEERING 2019; 2019:3815857. [PMID: 31198524 PMCID: PMC6526574 DOI: 10.1155/2019/3815857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 02/12/2019] [Accepted: 03/18/2019] [Indexed: 12/20/2022]
Abstract
Background Maternal health is an important part of basic public health services in China's medical reform. Effective management is an important guarantee of maternal health. Telemedicine has been widely used in maternal health management. Objective This study explores the role of usual healthcare combined with telemedicine in the management of high-risk pregnancy. Methods The study was a retrospective. Data were obtained from Hangzhou Maternity Hospital between October 2012 and September 2016, including 93465 pregnant women who were in usual high-risk pregnancy management (usual group) and 134884 pregnant women who were in telemedicine combined with usual high-risk pregnancy management (telemedicine group). The differences in high-risk scores and pregnancy outcomes between the usual and the telemedicine groups were compared. Results The high-risk factors were analyzed, and the results showed that the first fixed high-risk factor was scar uterus and the first dynamic high-risk factor was hepatitis B. Comparing the data of two groups, the number of prenatal visits increased significantly in the telemedicine group (p value <0.05). Although the critical proportion of high-risk women was 2.13% in the usual group and 5.88% in the telemedicine group, respectively (p value <0.01), maternal mortality decreased in the telemedicine group (p value <0.05). Conclusion The combination of telemedicine and usual healthcare can urge the pregnant women to carry out antenatal visits on time, which is one of the important factors to improve the outcome of high-risk pregnancy.
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Affiliation(s)
- Xu-Hong Zhu
- Department of Obstetrics and Gynecology, Hangzhou Women′s Hospital (Hangzhou Maternity and Child Health Care Hospital), No. 369, Kun Peng Road, Hangzhou, Zhejiang 310003, China
| | - Jing Tao
- Department of Obstetrics and Gynecology, Nanjing Medical University, No. 101, Ron Mian Road, Nanjing, Jiangshu 211166, China
| | - Li-Yuan Jiang
- Department of Obstetrics and Gynecology, Hangzhou Women′s Hospital (Hangzhou Maternity and Child Health Care Hospital), No. 369, Kun Peng Road, Hangzhou, Zhejiang 310003, China
| | - Zhi-Feng Zhang
- Department of Obstetrics and Gynecology, Hangzhou Women′s Hospital (Hangzhou Maternity and Child Health Care Hospital), No. 369, Kun Peng Road, Hangzhou, Zhejiang 310003, China
- Department of Obstetrics and Gynecology, Nanjing Medical University, No. 101, Ron Mian Road, Nanjing, Jiangshu 211166, China
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Escobar-Curbelo L, Franco-Moreno AI. Application of Telemedicine for the Control of Patients with Acute and Chronic Heart Diseases. Telemed J E Health 2018; 25:1033-1039. [PMID: 30632923 DOI: 10.1089/tmj.2018.0199] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Telemedicine (TM) has transformed the field of emergency cardiology, particularly the treatment of acute myocardial infarction (AMI). The ability to record an electrocardiogram (EKG) in the early prehospital phase, thus avoiding any delay in diagnosing myocardial infarction with direct transfer to the cath-lab for primary angioplasty, has proven to significantly reduce treatment times and mortality. Materials and Methods: We analyzed the available evidence and organizational models based on a support by TM in cardiology, including the applications of TM in cardiovascular disease based on a review of the literature. Results: The most important areas of application of TM in the field of cardiology are as follows: (1) Early prehospital diagnosis of AMI with EKG transmission; (2) Patient Remote control through wearable and devices; (3) Monitoring of patients with chronic heart failure; (4) Monitoring of patient's arrhythmias; and (5) Transmission of echo images to a III level center for a "second opinion". Conclusions: TM services should, therefore, be considered as a true diagnostic/therapeutic aspect of cardiovascular emergencies. It is necessary to educate medical staff and to provide a tempting environment for software engineers. Investing in infrastructure and equipment is imperative, as well as a positive climate for its implementation.
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