Diagnostic equivalency of mobile CTG devices and remote analysis to conventional on-site nonstress test

Abstract

Background.Remote pregnancy monitoring is one of the most promising applications of telemedicine; however, the diagnostic value of self-examination using mobile cardiotocography (CTG) devices and remote analysis of the subsequent results has never been properly studied.Objectives. The study aimed to compare the diagnostic usefulness of CTG self-examination using a mobile device to examination performed by a medical professional using a stationary device; and to evaluate the quality of CTG analysis performed remotely.Material and methods. Eighty-two pairs of CTG recordings were collected; each pair consisted of a single recording from an examination performed by a midwife using a stationary device, and another recording from an unassisted patient self-examination using a mobile device. Recordings were performed with a maximum time interval of 30 min. Each recording was analyzed twice. Primary analysis included a comparison of the assisted examination evaluated on-site vs the self-examination evaluated remotely in pairs. Secondary analysis was conducted by an independent expert who evaluated the unpaired recordings. Baseline fetal heart rate (BFHR) values were compared independently. Results.We found that patients were more likely to perform inconclusive recordings than experienced midwives; however, the self-examination feasibility was satisfactory. The primary analysis showed 88.4% agreement of the recorded pairs; 11.6% of inconsistent pairs were due to inter-observer variability or medical reasons. The independent expert's analysis showed 97. 1% agreement between the assisted and unassisted examinations. Paired t-test for BFHR values showed a statistically significant but clinically negligible mean difference between the 2 devices at 1.75 bpm. Conclusions.The CTG examinations performed using mobile devices present satisfactory feasibility and equivalent diagnostic value compared to conventional devices, while the remote evaluation of recordings is as reliable as on-site analysis. Remote pregnancy surveillance is safe, effective and may be implemented into everyday obstetric care.

Application and Clinical Analysis of Remote Fetal Heart Rate Monitoring Platform in Continuous Fetal Heart Rate Monitoring Images

“…In recent years, with the full liberalization of the national second-child policy and the gradual increase of elderly pregnant women, the work pressure of the hospital's fetal heart rate monitoring department has also increased [1]. How to find a way that is convenient and guarantees the health and safety of pregnant women and the service diagnosis and treatment model to reduce the pressure of the fetal heart care unit in the hospital is a hot issue that everyone is concerned about.…”

Computerized cardiotocography analysis during labor – A state‐of‐the‐art review

“…Systems enabling women to monitor FHR and UC at home have been built in the last years, and several studies show that their quality is close to the quality of high‐grade cardiotocographs used in hospitals 62 . A qualitative study run by Van den Heuvel et al concluded that home‐based telemonitoring of fetal parameters could be of great use for high risk pregnancies, 63 and another study by Pilarczyk et al concluded that it should be implemented into everyday obstetric care 64 . As remote CTG monitoring may be performed without any medical practitioner around, the integration of computerized CTG analysis in the process will be particularly useful.…”

Telemedicine for home care of fetal growth restriction with mobile cardiotocography: A case series

“…The application of telemedicine in obstetrics can be categorized by the services provided (educational, teleconsultations, and remote monitoring) or by the problem addressed (lifestyle issues, maternal complications, and fetal complications). Remote pregnancy monitoring is one of the most promising applications of telemedicine, and our study categorized it as “remote monitoring for fetal complications.” 11 Several investigators have evaluated the efficacy and safety of home care management in obstetrics and demonstrated the safety of high‐risk pregnancies (including FGR). However, the evidence for this is limited.…”

“…Challenges with the management of patient burden exist in areas where obstetric facilities are limited, and, in high‐risk pregnancies, such as those with FGR, the use of iCTG would reduce the number of visits. Telemedicine can also improve access to medical services in rural and underdeveloped countries where the concentration of health centers is sparse 11 . In particular, our health facility is less easily accessible and may require 90 min of commute time for some patients.…”