Adaptation of prenatal care and ultrasound

Abstract

In the spring of 2020, expeditious changes to obstetric care were required in New York as cases of COVID-19 increased and pandemic panic ensued. A reduction of in-person office visits was planned with provider appointments scheduled to coincide with routine maternal blood tests and obstetric ultrasounds. Dating scans were combined with nuchal translucency assessments to reduce outpatient ultrasound visits. Telehealth was quickly adopted for selected prenatal visits and consultations when deemed appropriate. The more sensitive cell-free fetal DNA test was commonly used to screen for aneuploidy in an effort to decrease return visits for diagnostic genetic procedures. Antenatal testing guidelines were modified with a focus on providing evidence-based testing for maternal and fetal conditions. For complex pregnancies, fetal interventions were undertaken earlier to avoid serial surveillance and repeated in-person hospital visits. These rapid adaptations to traditional prenatal care were designed to decrease the risk of coronavirus exposure of patients, staff, and physicians while continuing to provide safe and comprehensive obstetric care.

Models of Incorporating Telehealth into Obstetric Care During the COVID-19 Pandemic, Its Benefits And Barriers: A Scoping Review

“…The majority of the included articles originated from the United States (n = 14, 56%). 11,22,23,[38][39][40][41][42][43][44][45][46][47][48]…”

“…However, some articles suggested conducting all obstetric visits virtually, except those that require laboratory testing, ultrasound, or other procedures. 11,17,20,23,41,42,49 Services such as ultrasounds, laboratory tests, physical examinations, genetic screenings, and vaccinations cannot be done virtually from home (Table 3). One exception is the protocol set forth by Dosaj et al, in which contracted pharmacies provide self-swab kits for sexually transmitted infection screenings.…”

“…42 Telehealth visits can be conducted to provide education, review medical history, discuss testing options and results, and conduct mental health and surgical site checks. 17,[21][22][23][40][41][42]48,50,51 Health care providers can assess incisions and surgical sites for normal deliveries or cesarean sections using highquality skin images sent by patients. 23,38,41,42 Telehealth can also be used to provide family support during delivery.…”

“…5,11,17,21-23, 38,40-43,48,50-52 Only nine articles reported postpartum care in their protocols. 5,11,17,22,23,38,41,50,51 The majority of the protocols were developed based on expert opinions, literature reviews, or recommendations by scientific societies (n = 13; 86.7%). The sources of these protocols are listed in Table 4.…”

“…These measures benefit both patients and health care professionals by encouraging social distancing and preventing unnecessary exposure to COVID-19. [19][20][21][22][23] Telehealth is defined as ''the use of electronic information and telecommunication technologies to support long-distance clinical health care, patient and professional health-related education, public health, and health administration.'' 24 Telehealth comprises three categories: (1) synchronized (real time), (2) asynchronized (store-and-forward), and (3) remote patient monitoring.…”