Am J Perinatol 2019; 36(07): 751-758
DOI: 10.1055/s-0038-1675158
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Implementation and Impact of a Maternal–Fetal Medicine Telemedicine Program

Cassandra Leighton
1   Health Policy Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
Molly Conroy
2   Department of General Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
Andrew Bilderback
3   Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Wendy Kalocay
4   Women's Telehealth Services, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
James K. Henderson
3   Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Hyagriv N. Simhan
5   Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
› Author Affiliations
Further Information

Publication History

09 November 2017

05 September 2018

Publication Date:
31 October 2018 (online)


Objective The increase in maternal morbidity has resulted in higher need for maternal–fetal medicine (MFM) subspecialty care. To meet the rising demand, particularly in rural areas, the use of MFM telemedicine services has increased. This study describes the structure, implementation, and patient and child health outcomes associated with a large health system's MFM telemedicine program.

Study Design Observational electronic health record data are used to compare maternal and childbirth outcomes between patients receiving care via telemedicine or in-person visits through regression analysis. Average patient time and resources saved are calculated, and patient satisfaction scores are reported.

Results The telemedicine patients experienced similar outcomes to the in-person group, indicating that MFM telemedicine can serve as an effective substitute for in-person care. MFM telemedicine patients saved $90.28 per consult in travel and work-related expenses. An overwhelming majority of MFM telemedicine patients were satisfied with their visit and indicated that they would be interested in receiving care via telemedicine in the future.

Conclusion The results indicate that the patients may benefit financially and experience similar outcomes when telemedicine programs are appropriately designed to eliminate access barriers and provide high-quality care.

  • References

  • 1 Menard MK, Kilpatrick S, Saade G. , et al; American College of Obstetricians and Gynecologists and Society for Maternal–Fetal Medicine. Levels of maternal care. Am J Obstet Gynecol 2015; 212 (03) 259-271
  • 2 Callaghan WM, Creanga AA, Kuklina EV. Severe maternal morbidity among delivery and postpartum hospitalizations in the United States. Obstet Gynecol 2012; 120 (05) 1029-1036
  • 3 AHRQ. Measures: Availability of Outpatient Maternal Fetal Medicine and Specialty Care for Women with High-Risk Pregnancies and Availability of Multidisciplinary Outpatient Care for Women with High-Risk Pregnancies. Rockville: Centers for Medicare & Medicaid Services; 2015
  • 4 Hankins GD, Clark SL, Pacheco LD, OʼKeeffe D, DʼAlton M, Saade GR. Maternal mortality, near misses, and severe morbidity: lowering rates through designated levels of maternity care. Obstet Gynecol 2012; 120 (04) 929-934
  • 5 Rayburn WF, Klagholz JC, Elwell EC, Strunk AL. Maternal-fetal medicine workforce in the United States. Am J Perinatol 2012; 29 (09) 741-746
  • 6 Sciscione A, Berghella V, Blackwell S. , et al; Society for Maternal-Fetal Medicine (SMFM). Society for maternal-fetal medicine (SMFM) special report: the maternal-fetal medicine subspecialists' role within a health care system. Am J Obstet Gynecol 2014; 211 (06) 607-616
  • 7 Sullivan SA, Hill EG, Newman RB, Menard MK. Maternal-fetal medicine specialist density is inversely associated with maternal mortality ratios. Am J Obstet Gynecol 2005; 193 (3 Pt 2): 1083-1088
  • 8 McCrossan BA, Sands AJ, Kileen T, Doherty NN, Casey FA. A fetal telecardiology service: patient preference and socio-economic factors. Prenat Diagn 2012; 32 (09) 883-887
  • 9 Norum J, Bergmo TS, Holdø B. , et al. A tele-obstetric broadband service including ultrasound, videoconferencing and cardiotocogram. A high cost and a low volume of patients. J Telemed Telecare 2007; 13 (04) 180-184
  • 10 Dalfrà MG, Nicolucci A, Lapolla A. ; TISG. The effect of telemedicine on outcome and quality of life in pregnant women with diabetes. J Telemed Telecare 2009; 15 (05) 238-242
  • 11 Mastrogiannis DS, Igwe E, Homko CJ. The role of telemedicine in the management of the pregnancy complicated by diabetes. Curr Diab Rep 2013; 13 (01) 1-5
  • 12 Chilelli NC, Dalfrà MG, Lapolla A. The emerging role of telemedicine in managing glycemic control and psychobehavioral aspects of pregnancy complicated by diabetes. Int J Telemed Appl 2014; 2014: 621384
  • 13 Rasekaba TM, Lim K, Blackberry I, Gray K, Furler J. Telemedicine for Gestational Diabetes Mellitus (TeleGDM): a mixed-method study protocol of effects of a web-based GDM support system on health service utilization, maternal and fetal outcomes, costs, and user experience. JMIR Res Protoc 2016; 5 (03) e163
  • 14 Zairina E, Abramson MJ, McDonald CF. , et al. Study protocol for a randomised controlled trial evaluating the efficacy of a telehealth program--management of asthma with supportive telehealth of respiratory function in pregnancy (MASTERY©). BMC Pulm Med 2015; 15: 84
  • 15 Wyatt SN, Rhoads SJ, Green AL, Ott RE, Sandlin AT, Magann EF. Maternal response to high-risk obstetric telemedicine consults when perinatal prognosis is poor. Aust N Z J Obstet Gynaecol 2013; 53 (05) 494-497
  • 16 Britt DW, Bronstein J, Norton JD. Absorbing and transferring risk: assessing the impact of a statewide high-risk-pregnancy telemedical program on VLBW maternal transports. BMC Pregnancy Childbirth 2006; 6: 11
  • 17 Britt DW. A qualitative comparative analysis of the conditions affecting early maternal transfer patterns. J Telemed Telecare 2006; 12 (08) 392-395
  • 18 Magann EF, Bronstein J, McKelvey SS, Wendel P, Smith DM, Lowery CL. Evolving trends in maternal fetal medicine referrals in a rural state using telemedicine. Arch Gynecol Obstet 2012; 286 (06) 1383-1392
  • 19 Long MC, Angtuaco T, Lowery C. Ultrasound in telemedicine: its impact in high-risk obstetric health care delivery. Ultrasound Q 2014; 30 (03) 167-172
  • 20 The Center for Rural Pennsylvania. Rural Pennsylvania Minority Population. Harrisburg, PA; 2012. . Available at: . Accessed May 14, 2019
  • 21 Hoadley J, Wagnerman K, Alker J, Holmes M. Medicaid in Small Towns and Rural America: A Lifeline for Children, Families, and Communities. Washington, D.C.: Georgetown University & University of North Carolina; 2017