Assist. Prof. Dr. Döndü Kurnaz, PhD, Marmara University Faculty of Health Sciences Midwifery Department, Istanbul, Turkey.
PhD., Ministry of Health Adana Provincial Directorate of Health Emergency Health Services, Adana,Turkey.
Midwifery. 2024 Jul;134:104017. doi: 10.1016/j.midw.2024.104017. Epub 2024 Apr 23.
This review was conducted to examine the effectiveness of antenatal follow-up using telehealth in the pre-COVID-19 and active pandemic periods.
A systematic review and meta-analysis of randomized controlled trials.
Searches were conducted from inception to September 2023 through PubMed, the Cochrane Library, EBSCO, Embase, Web of Science, all via Ovid SP, the National Thesis Center, TR Index, Turkiye Clinics, and DergiPark Academic. Data were combined in the meta-analysis. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool and quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation guidelines.
The meta-analysis examining the effectiveness of antenatal telehealth services included 35 studies with a total sample size of 16 033. The combined results of the studies revealed that antenatal telehealth services were similar to face-to-face follow-ups for many maternal and newborn health outcomes. Maternal outcomes included abortion, preterm delivery, gestational diabetes, weight gain, hypertensive disorders, maternal hospitalization, number of antenatal follow-ups, use of induction, vaginal and instrumental delivery, planned and emergency cesarean section, shoulder dystocia, episiotomy, perineal laceration, childbirth under the supervision of qualified personnel, breastfeeding problems and postpartum depression. Neonatal outcomes included an APGAR score of <7, neonatal hypoglycemia, hyperbilirubinemia, admission into the neonatal intensive care unit, respiratory distress syndrome, neonatal death, birth weight, low birth weight and macrosomia. However, statistically significant reductions in excessive weight gain (p<0.001) and a 1.23-fold increase in vaccination administration (p=0.001) were observed with telehealth services. Additionally, the effects of telehealth services on preterm and cesarean delivery rates were similar in the pre-pandemic and pandemic periods.
This review reveals that while antenatal telehealth services are comparable to face-to-face care in terms of multiple pregnancy, delivery, and neonatal outcomes, they contribute to improvements in preventing extreme weight gain and vaccination hesitancy. These findings suggest that the telehealth method can be used as an alternative to face-to-face monitoring in antenatal follow-ups.
本综述旨在考察新冠疫情前和活跃大流行期间，使用远程医疗进行产前随访的效果。
系统综述和荟萃分析的随机对照试验。
从建库到 2023 年 9 月，通过 PubMed、Cochrane 图书馆、EBSCO、Embase、Web of Science、ovid SP 中的所有内容、国家论文中心、TR 索引、土耳其诊所和 DergiPark 学术资源进行检索。数据合并进行荟萃分析。使用 Cochrane 风险偏倚工具 2 评估风险偏倚，并根据推荐评估、制定和评估指南评估证据质量。
荟萃分析检查了产前远程医疗服务的有效性，共纳入 35 项研究，总样本量为 16033 例。研究的综合结果表明，产前远程医疗服务在许多母婴健康结果方面与面对面随访相似。产妇结局包括流产、早产、妊娠期糖尿病、体重增加、高血压疾病、产妇住院、产前随访次数、引产、阴道和器械分娩、计划和紧急剖宫产、肩难产、会阴切开术、会阴裂伤、在合格人员监督下分娩、母乳喂养问题和产后抑郁。新生儿结局包括新生儿 Apgar 评分<7、新生儿低血糖、高胆红素血症、新生儿重症监护病房入院、呼吸窘迫综合征、新生儿死亡、出生体重、低出生体重和巨大儿。然而，远程医疗服务可显著减少体重过度增加（p<0.001）和疫苗接种率增加 1.23 倍（p=0.001）。此外，远程医疗服务对早产和剖宫产率的影响在大流行前和大流行期间相似。
本综述表明，虽然产前远程医疗服务在妊娠、分娩和新生儿结局方面与面对面护理相当，但它们有助于预防体重过度增加和疫苗接种犹豫。这些发现表明，远程医疗方法可作为产前随访中面对面监测的替代方法。
