Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York.
Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York.
Am J Perinatol. 2020 Jun;37(8):800-808. doi: 10.1055/s-0040-1712121. Epub 2020 May 12.
As New York City became an international epicenter of the novel coronavirus disease 2019 (COVID-19) pandemic, telehealth was rapidly integrated into prenatal care at Columbia University Irving Medical Center, an academic hospital system in Manhattan. Goals of implementation were to consolidate in-person prenatal screening, surveillance, and examinations into fewer in-person visits while maintaining patient access to ongoing antenatal care and subspecialty consultations via telehealth virtual visits. The rationale for this change was to minimize patient travel and thus risk for COVID-19 exposure. Because a large portion of obstetric patients had underlying medical or fetal conditions placing them at increased risk for adverse outcomes, prenatal care telehealth regimens were tailored for increased surveillance and/or counseling. Based on the incorporation of telehealth into prenatal care for high-risk patients, specific recommendations are made for the following conditions, clinical scenarios, and services: (1) hypertensive disorders of pregnancy including preeclampsia, gestational hypertension, and chronic hypertension; (2) pregestational and gestational diabetes mellitus; (3) maternal cardiovascular disease; (4) maternal neurologic conditions; (5) history of preterm birth and poor obstetrical history including prior stillbirth; (6) fetal conditions such as intrauterine growth restriction, congenital anomalies, and multiple gestations including monochorionic placentation; (7) genetic counseling; (8) mental health services; (9) obstetric anesthesia consultations; and (10) postpartum care. While telehealth virtual visits do not fully replace in-person encounters during prenatal care, they do offer a means of reducing potential patient and provider exposure to COVID-19 while providing consolidated in-person testing and services. KEY POINTS: · Telehealth for prenatal care is feasible.. · Telehealth may reduce coronavirus exposure during prenatal care.. · Telehealth should be tailored for high risk prenatal patients..
随着纽约市成为新型冠状病毒病 2019（COVID-19）大流行的国际中心，远程医疗迅速被纳入曼哈顿哥伦比亚大学欧文医学中心的产前保健中。实施的目标是将面对面的产前筛查、监测和检查整合到更少的面对面访问中，同时通过远程医疗虚拟访问保持患者获得持续的产前护理和专科咨询。这种变化的理由是尽量减少患者的旅行，从而降低 COVID-19 的暴露风险。由于很大一部分产科患者存在使他们处于不良后果风险增加的潜在医疗或胎儿状况，因此针对增加的监测和/或咨询来定制产前保健远程医疗方案。基于将远程医疗纳入高危患者的产前护理，针对以下情况、临床情况和服务提出了具体建议：（1）妊娠高血压疾病，包括子痫前期、妊娠期高血压和慢性高血压；（2）孕前和妊娠期糖尿病；（3）母体心血管疾病；（4）母体神经病学疾病；（5）早产史和不良产科史，包括先前的死胎；（6）胎儿状况，如宫内生长受限、先天性异常和多胎妊娠，包括单绒毛膜胎盘；（7）遗传咨询；（8）心理健康服务；（9）产科麻醉咨询；和（10）产后护理。虽然远程医疗虚拟访问不能完全替代产前护理中的面对面访问，但它们确实提供了一种减少患者和提供者接触 COVID-19 的方法，同时提供了整合的面对面测试和服务。要点：·产前保健中的远程医疗是可行的。·远程医疗可能会减少产前护理期间冠状病毒的暴露。·远程医疗应针对高危产前患者进行定制。
