Telehealth for High-Risk Pregnancies in the Setting of the COVID-19 Pandemic

Abstract

As New York City became an international epicenter of the novel coronavirus disease 2020 (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

Respectful maternity care in the context of COVID‐19: A human rights perspective

“…Several studies have not shown worse outcomes, even for women at high risk. 3,4 However, reliance on telehealth for prenatal care excludes people impacted by the "digital divide"-inequitable access to or use of remote communications technologies-such as those living in certain areas with low Internet connectivity, those who are poor and have no access to the hardware necessary for such visits (tablets, laptops, or computers), and those with poor technical literacy. 5 Restrictions against a companion being present during labor and delivery were widespread at the outset of the pandemic, depriving women of an option that has been shown to not only improve the childbirth experience and outcomes, but also prevent other forms of mistreatment during childbirth.…”

Good Practices in Perinatal Mental Health during the COVID-19 Pandemic: A Report from Task-Force RISEUP-PPD COVID-19

“…During the COVID-19 pandemic, prenatal and psychological services have been rapidly changing from face-to-face to online (Aziz et al, 2020;Zhou et al, 2020). For example, two hospitals and an affiliated clinic in New York City offered telehealth prenatal appointments during the COVID-19 outbreak.…”

“…Regarding mental health support, they proposed a prior in-person session before starting the telehealth to ensure clinician-patient alliance. If there were specific concerns about domestic violence or any abusive relationship in the home environment, these issues would be discussed in this initial session as well (Aziz et al, 2020). Additionally, access to psychosocial support groups should be provided, even as an online service.…”

Consensus Scientific Statement on Advisory Working Guidelines and Recommendations for the Female Population in COVID-19 Era by WINCARS

“…Physical visits to the diabetes care team can be timed along with visits to the obstetrician and ultrasounds. [91][92][93][94] Oral glucose tolerance test (OGTT) at 24 to 28 weeks remains the gold standard for detecting gestational diabetes mellitus (GDM). However, as this would require repeated phlebotomy and more time spent at the specimen collection center, many experts have argued that this would increase the women's risk of acquiring COVID-19 infection.…”