Effects of the Intervention Model Based on Telehealth and Education for the Management of Obstetric Emergencies in Latin America

Abstract

Background: Rural populations are commonly characterized by poverty, low educational level, and poor access to health services, and pregnant women often lack adherence to prenatal care. Referral of obstetric patients in critical conditions from these areas is associated with high maternal morbidity/mortality. We thought to identify changes in maternal/perinatal care quality indicators after implementing a model based on telehealth and education for patients with obstetric emergencies between two hospitals in a southwestern region of Colombia.Methods: An ecological study was conducted between 2017 to 2019 to compare before and after obstetric emergency care through telemedicine from a secondary care center (Hospital Francisco de Paula Santander-HFPS) to the referral center (Fundación Valle del Lili-FVL). The project included verification visits to determine the installed capacity of care, a concerted improvement plan, an on-site education project supported by simulation in eight obstetric and perinatal care modules, and the strengthening of non-technical competencies. The communication platform between institutions was a technological development of the FVL, and the telecalls were made through licensed platforms.Findings: 102 patients were treated before, and 148 after telemedicine implementation. The clinical indicators after model implementation showed a significant reduction in perinatal mortality of 29%. An effect statistically significant for outcome maternal did not found, however, was observed a reduction in the need for transfusion of blood products due to postpartum hemorrhage (PPH), as well as the rate of eclampsia.Interpretation: Implementing a model based on telehealth and education between secondary and tertiary care centers allowed the strengthening of the security of care in obstetric emergencies, and significantly impacted perinatal mortality.Funding: Fundación Valle del Lili