Telemedicine and Its Uses During Pregnancy

Introduction:

With better access to specialty care, globally, maternal morbidity (short or long-term health problems that result from being pregnant and giving birth) and the maternal mortality rate has been improving. But their rates persist in rural areas and are much higher in rural areas than in urban areas. This is due to the limitations in accessing timely good quality medical services due to barriers in transportation. One proposed method to address these issues is the telemedicine platform. In addition, technological advancement has increased the use of mobile phone apps, text messaging, multimedia messaging, and live audio-visual communications, which has led to an increase in technology-enhanced healthcare delivery.

What Is Telemedicine?

Telemedicine is medical services provided by health care professionals using technology to exchange electronic information (diagnosis, treatment, and disease prevention).

What Are the Advantages of Telemedicine?

• Telemedicine can compensate for the geographical distance gap, ceases issues, and provides good healthcare facilities in remote areas.

• They increase access to specialty care for patients who stay in regions lacking specialists.

• They also allow more timely delivery of services, usually within minutes or hours when the need arises.

• It is a tool for public awareness and disaster management.

• Patients can seek second opinions and complex interpretations through telemedicine.

• Telemedicine provides confidentiality for all medical services, a platform to meet maternal needs even in the pandemic, and an excellent solution for overburdened healthcare systems.

Telemedicine does not replace the current standard of care. Instead, it enhances the standard of health care.

How Is Telemedicine Useful in Pregnancy?

Pregnancy care is thought of as high-touch care. Pregnancy evaluation is very important for both mother and the fetus. A wide range of healthcare services can be provided through telemedicine during and after pregnancy. Telemedicine helps pregnant women establish the quality of care without ever compromising on the perinatal outcome. They also limit unnecessary traveling and save enough time for patient's time. Telemedicine has also been used for innovative approaches to prenatal and postnatal care. Having specialists accessible through telemedicine, local healthcare providers can also maintain their high-risk patients and safely conduct more deliveries in their nearby and respective hospitals.

Telemedicine has been used for video or phone consultations with specialists like obstetricians, mental healthcare providers (psychiatrists or psychologists), and lactation consultants. In addition, for conditions that require at-home monitoring, like hypertension or diabetes, fetal heart rate monitoring can also be done through telemedicine.

1. Communication With Providers: Telemedicine enables direct communication with healthcare providers through web-based apps or online platforms. Platforms like these include provider information, appointment reminders, and pregnancy education.

• Antenatal Care With Telemedicine: Antenatal care refers to the care received by healthcare professionals during pregnancy. Traditionally, throughout the pregnancy, prenatal care requires about 12 to 14 in-person visits. Most of these visits are to answer any doubts or questions, provide patient education, and monitor the vitals of both mother and fetus. Visits that include lab tests, vaccinations, and ultrasounds require in-person care. These in-person visits require time away from work, family responsibilities, and traveling. Research suggests that fewer prenatal visits are the safest option for lower-risk pregnancies. To replace inpatient visits, some medical centers have started using virtual visits in telemedicine through phone or video conferences. Telemedicine decreases the frequency of in-person visits without decreasing the quality of care. Through the virtual visits, the patients are given supplies and instructions to monitor their weight, blood pressure, fundal height (distance between the public bone and the top of the uterus used to track fetal growth), and fetal heart rate at home. Measures like these allow patients to maintain their continued care with the healthcare providers by staying at home. It is beneficial for people who have to travel long distances for healthcare facilities or face issues in taking time off from work.

• At-Home Monitoring Through Telemedicine: High-risk pregnancies have benefited from telemedicine through at-home monitoring devices for diabetes and high blood pressure. Studies have shown that the use of telemedicine for monitoring glucose control in pregnancy is as effective as standard care. In addition, women with gestational diabetes had similar outcomes between traditional care and telemedicine. With telemedicine, hypertensive pregnant patients monitor their blood pressure at home, and their results obtained will be sent to the providers. The provider decides whether an inpatient evaluation is needed or not.

2. Video or Phone Consultations With Specialists

Many rural areas lack access to specialists. With telemedicine, patients can make a video or phone consultation appointment with a specialist rather than traveling and seeing them in person. Not only can specialists evaluate patients remotely and suggest treatment plans, but they can also review ultrasound imaging with a remote technician conducting the imaging studies.

3. Postpartum Visits With Telemedicine

Postpartum visits mainly address the patient's physical, emotional, and social well-being, contraceptive needs, and management of any ongoing disease. Most postpartum care begins within three weeks of delivery, but most patients fail to follow up. Studies have shown that the first year of postpartum poses the highest morbidity risk, and consistent care is required for the wellness of both mother and the child. Telemedicine could address this issue, and postpartum care easily provided can be quickly sorted.

4. Lactation Support With Telemedicine

By using telemedicine platforms, women with breastfeeding difficulties can make appointments with lactation consultations and consult them from their homes.

5. Telemedicine for Newborn Care

The newborn babies' wellness can be assessed by the mother enquiring about the baby's urine output, activity, crying, and adequate feeding.

6. Mental Health Consultations With Telemedicine

Mental health services are required for many women during pregnancy or postpartum. These can include help for postpartum depression, anxiety, postpartum psychosis, substance abuse disorders, and trauma. For example, a review showed that behavioral therapy through phones or apps significantly improved maternal depression cases.

What Are the Challenges Posed by Telemedicine?

• The perspectives of medical practitioners pose a challenge to telemedicine. Some doctors need to be fully convinced or familiar with telemedicine.

• Patients lack confidence in the outcome of telemedicine.

• Limited computer literacy and inadequate internet access are challenges for virtual visits.

• Patients with low health knowledge, poor patients, and those who live in rural areas might find difficulties in accessing the technology and equipment necessary for virtual telemedicine visits.

• Lab tests and imaging tests will require an inpatient visit.

• Despite the expansion of telemedicine during the pandemic, regulatory and legal issues like malpractice insurance, licensing, billing, and data transmission privacy complicates the implementation of telemedicine services.

Conclusion:

Telemedicine can be integrated with pregnancy (prenatal and postpartum care) in several ways. First, they address the urban-rural differences by improving access to specialists. Despite a few challenges like inadequate internet access and limited computer knowledge, expanding the reach of telemedicine from urban areas to rural and underserved communities improves the health outcomes of both mother and the fetus