Hospital-grade antenatal care delivered virtually

Trials of an antenatal care program delivered by telehealth have demonstrated a level of care provision that is as good as a face-to-face consultation, including the identification of common complications.

The majority of antenatal appointments usually occur face-to-face within a hospital environment, but a collaborative study conducted by Monash University and Monash Health integrated an antenatal care program delivered via telehealth between 20 April and 26 July 2020. The program successfully reduced face-to-face consultations by 50% without affecting the detection and management of common pregnancy complications, including pre-eclampsia, foetal growth restriction and gestational diabetes, when compared with conventionally delivered antenatal care.

Developed by a multidisciplinary team of obstetric, midwifery and general practice providers, telehealth consultations were supplemented with a suite of patient and staff information sheets, and systems to support remote blood pressure checks and foetal growth assessments.

“It was clear that antenatal care delivery had to be adapted to protect pregnant women and staff from unnecessary exposure to the virus [SARS-CoV-2],” said study first author Dr Kirsten Palmer from the Monash University School of Clinical Sciences and Monash Health.

“We recognised that a key limitation of telehealth was the inability to do physical examinations, which are essential in antenatal care, but we were able to implement low-cost measures to support these assessments in the home.”

Blood pressure was self-checked on purchased automated blood pressure monitors, with local health providers, or at the time of hospital ultrasound assessments.

Remote monitoring of foetal growth involved the introduction of self-measured symphyseal-fundal heights weekly from 24 weeks’ gestation plotted on provided foetal growth charts supported by educational material, and ultrasound assessment of foetal growth was done in hospital according to national clinical care recommendations.

The findings are published in The Lancet.

After implementing telehealth on 23 March 2020 — following the federal government’s announcement of funding support — Monash Health has delivered more than 40,000 antenatal consultations via telehealth, with data from the integrated antenatal care program (April–July 2020) confirming that women were still receiving the same high-quality care as they had with the traditional in-person visits.

Program Director of the Women’s and Newborn Program and Director of Obstetric Services at Monash Health Associate Professor Ryan Hodges added, “Although telehealth was implemented during a global health crisis, which facilitated the rapid development and uptake of telehealth, this program might provide many benefits for the future delivery of antenatal care and minimise risk in a future epidemic.

“We are hoping to continue it as part of our antenatal care program as it supports women to receive more personalised care with the same excellent outcomes.”

Dr Palmer concluded, “We have shown that such an approach seems to be safe for continuing to achieve a high standard of pregnancy care.”

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