Chapter 6: High-Risk Obstetrics and Telehealth

High-risk pregnancies “threaten the health or life of the mother or her fetus” and are often prompted by certain risk factors like “existing health conditions, such as high blood pressure, diabetes, or being HIV-positive; overweight and obesity; multiple births, and young or old maternal age.” ¹ The National Institutes of Health recommend that high-risk pregnancies receive the care of a “special team of health care providers” to ensure healthy outcomes for both mothers and their infants. ¹ However, such a “special team” represents a professional resource that is swiftly dwindling. The American Congress of Obstetricians and Gynecologists project that the United States will lack 6,000 to 8,000 obstetricians by the year 2020, with a potential shortage of 22,000 by 2050. ² Even scarcer are obstetricians, like maternal-fetal medicine specialists, prepared to handle high-risk pregnancies. Considering this need and shortage, telemedicine becomes a natural means of distributing specialty high-risk obstetrical expertise in an efficient manner.

MODALITIES

High-risk obstetrical telehealth has been used to provide a number of support, diagnostic, and ancillary services, including nonstress testing, fetal echocardiograms, hypertension and diabetes counseling, and monitoring. Nonstress testing, meaning no stress placed on the fetus, is done by placing a belt with a sensor on the abdomen of the mother to monitor fetal heart rate in response to fetal movement. ³ Fetal echocardiograms use ultrasound to evaluate the heart of the fetus and assess for cardiac abnormalities prior to birth. These tests are performed most often in the second trimester and provide a more detailed image than a regular ultrasound, showing blood flow, structure, and heart rhythm. ⁴ Each of these test results can be read in the office or remotely via real-time teleultrasounds and video technology. Common medical complications in high-risk pregnancies, such as hypertension and diabetes, can also be remotely monitored through the use of a handheld or wearable device and can be used as an educational/counseling tool. Increasingly, high-risk obstetrical telehealth is making its way into the home, providing patients the opportunity to increase time between required clinic visits, replace visits, or offer physicians rich data on patients in between appointments. This amazing evolution of high-risk obstetrical care is currently underway and is expected to change drastically in the future, with the anticipation that obstetrical societies and authorities will endorse certain practices for clinical reliability.

There are a number of different ways to incorporate telehealth in high-risk obstetrics. Each of these modalities can be used to consult, diagnose, treat, and educate. First and foremost, these modalities all have a common theme in consulting and treating high-risk obstetrical patients: each provides gateways for expectant mothers to receive specialized care needed to achieve optimal maternal and antenatal health.

Live, two-way synchronous audio and video allows specialists, local providers, and obstetrical patients to see and hear each other in real time to discuss high-risk obstetrical conditions (see Figure 6-1). This modality places the specialist virtually into ...