Effectiveness of Remote Fetal Monitoring on Maternal-Fetal Outcomes: Systematic Review and Meta-Analysis

Abstract

Background To solve the disadvantages of traditional fetal monitoring such as time-consuming, cumbersome steps and low coverage, it is paramount to develop remote fetal monitoring. Remote fetal monitoring expands time and space, which is expected to popularize fetal monitoring in remote areas with the low availability of health services. Pregnant women can transmit fetal monitoring data from remote monitoring terminals to the central monitoring station so that doctors can interpret it remotely and detect fetal hypoxia in time. Fetal monitoring involving remote technology has also been carried out, but with some conflicting results. Objective The review aimed to (1) examine the efficacy of remote fetal monitoring in improving maternal-fetal outcomes and (2) identify research gaps in the field to make recommendations for future research. Methods We did a systematic literature search with PubMed, Cochrane Library, Web of Science, Embase, MEDLINE, CINAHL, ProQuest Dissertations and Theses Global, ClinicalTrials.gov, and Open Grey in March 2022. Randomized controlled trials or quasi-experimental trials of remote fetal monitoring were identified. Two reviewers independently searched articles, extracted data, and assessed each study. Primary outcomes (maternal-fetal outcomes) and secondary outcomes (health care usage) were presented as relative risks or mean difference. The review was registered on PROSPERO as CRD42020165038. Results Of the 9337 retrieved literature, 9 studies were included in the systematic review and meta-analysis (n=1128). Compared with a control group, remote fetal monitoring reduced the risk of neonatal asphyxia (risk ratio 0.66, 95% CI 0.45-0.97; P=.04), with a low heterogeneity of 24%. Other maternal-fetal outcomes did not differ significantly between remote fetal monitoring and routine fetal monitoring, such as cesarean section (P=.21; I2=0%), induced labor (P=.50; I2=0%), instrumental vaginal birth (P=.45; I2=0%), spontaneous delivery (P=.85; I2=0%), gestational weeks at delivery (P=.35; I2=0%), premature delivery (P=.47; I2=0%), and low birth weight (P=.71; I2=0%). Only 2 studies performed a cost analysis, stating that remote fetal monitoring can contribute to reductions in health care costs when compared with conventional care. In addition, remote fetal monitoring might affect the number of visits and duration in the hospital, but it was not possible to draw definite conclusions about the effects due to the limited number of studies. Conclusions Remote fetal monitoring seems to reduce the incidence of neonatal asphyxia and health care costs compared with routine fetal monitoring. To strengthen the claims on the efficacy of remote fetal monitoring, further well-designed studies are necessary, especially in high-risk pregnant women, such as pregnant women with diabetes, pregnant women with hypertension, and so forth.

Antenatal Noninvasive Fetal Electrocardiography: A Literature Review

“…This challenge is primarily due to the low amplitude of the fetal ECG compared to the maternal and general electrical noise captured by the device, resulting in larger signal loss than observed in cCTG. There are a multitude of factors that affect this phenomenon, and one of the larger studies observing the use of NIFECG in the antenatal period confirmed that signal loss is associated with gestation 66,67 . This study reports the relationship of gestation and signal loss as linear; however, other studies have shown that although there is a good level of signal acquisition toward the end of the second trimester, the principal time of signal loss is 26–34 weeks of gestation.…”

“…There are a multitude of factors that affect this phenomenon, and one of the larger studies observing the use of NIFECG in the antenatal period confirmed that signal loss is associated with gestation. 66,67 This study reports the relationship of gestation and signal loss as linear; however, other studies have shown that although there is a good level of signal acquisition toward the end of the second trimester, the principal time of signal loss is 26-34 weeks of gestation. This coincides with the presence of the vernix caseosa, which is hypothesized to decrease signal conductance.…”

“…43 A recent systematic review illustrated the difference in signal acceptance thresholds over different studies exploring the use of NIFECG. 67 This can vary from >34% of a trace being acceptable to >80% of being accepted as an interpretable trace. 66…”

“…Regarding the cCTG, signal loss is defined as the percentage of 3.75 second epochs in which the HR lies outside of the 30 and 240 bpm intervals 43 . A recent systematic review illustrated the difference in signal acceptance thresholds over different studies exploring the use of NIFECG 67 . This can vary from >34% of a trace being acceptable to >80% of being accepted as an interpretable trace 66 …”

Expectations related to home‐based telemonitoring of high‐risk pregnancies: A qualitative study addressing healthcare providers' and users' views in Norway

“… 4 , 5 In addition, telemonitoring may be associated with lower costs without compromising health outcomes. 4 , 7 Nevertheless, studies are needed to develop and assess the acceptability and efficiency of comprehensive remote monitoring of women with high‐risk pregnancies 8 and their fetuses.…”