Advances in obstetric telemonitoring: a systematic review.

Abstract

Obstetric telemonitoring can improve gestational care, reducing the need fortravel, and can be used in different contexts to enable early detection of complications and prevention of intercurrences, providing local intervention before hospitalization. This paper aims to identify advances, contributions and limitations of obstetric telemonitoring using mobile technologies. A systematic review was performed on the Pubmed, Medline, LILACS, Cochrane, Scielo, Embase, ACM Surveys, and IEEE databases, from 2008 to 2018. PRISMA and CASP were used to analyze methodological rigour. 26 papers were included. The majority of the studies related to pregnant women, prenatal care, high-risk pregnancies and homecare. Only 2 articles related to postpartum and none related to delivery. Among the technological resources, the articles presented smartphone applications, which interact with external telemonitoring devices (such as electrodes attached to the body and thermometers) or request information about maternal and / or fetal health status. Based on those devices, decision-making by health professionals is more reliable, since data is obtained by digital devices that have a greater accuracy. The variety of studies is enormous and achieve promising results. However, there are still important gaps to be addressed. Many studies only cover isolated aspects of maternal health, e.g. blood pressure, which somehow limits clinical decision-making. All authors have described concerns about usability, but not all of them had actually performed usability tests. Interventions through obstetric telemonitoring can be applied to a wide range of domains, at various levels of healthcare complexity. There are still few investments in studies in developing countries, where maternal and fetal morbidity and mortality are higher. The area of obstetrical telemonitoring has a great potential for contributing with better gestational outcomes, early detection of complications, prevention of intercurrences, providing local intervention even before hospitalization. Development of obstetric telemonitoring systems wich collect complete obstetric parameter integrated with the periods of childbirth and postpartum is recommended.