The COVID-19 pandemic has seen telehealth become a fundamental component of healthcare. However maternity care presented a unique challenge, with the majority of antenatal appointments usually occurring face-to-face within a hospital environment.
In a recent collaborative study between Monash University and Monash Health, an integrated antenatal care program delivered via telehealth between April 20 and July 26, 2020, successfully reduced face-to-face consultations by 50 per cent 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.
The study’s first author, Dr Kirsten Palmer from the Monash University School of Clinical Sciences and Monash Health, said: "It was clear that antenatal care delivery had to be adapted to protect pregnant women and staff from unnecessary exposure to the virus.
"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 were recently published in The Lancet.
Monash Health is the largest publicly funded maternity service in Melbourne and provides approximately 100,000 antenatal consultations for the 10,000 women who give birth with the health service annually.
After implementing telehealth on 23 March, 2020, following the federal government’s announcement of funding support, Monash Health has delivered over 40,000 antenatal consultations via telehealth, with the data from the integrated antenatal care program (April - July 2020) timeframe 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 programme 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 said: "We have shown that such an approach seems to be safe for continuing to achieve a high standard of pregnancy care."
Read the full paper in the Lancet titled: Widespread implementation of a low-cost telehealth service in the delivery of antenatal care during the COVID-19 pandemic: an interrupted time-series analysisDOI: 10.1016/S0140-6736(21)00668-1