Telehealth in High Risk Telehealth in High Risk PregnancyPregnancy

By: Betty Lum, RNBy: Betty Lum, RN

High Risk PregnancyHigh Risk Pregnancy

• High risk pregnancies are determined by medical conditions High risk pregnancies are determined by medical conditions such as high blood pressure, gestational diabetes, chronic such as high blood pressure, gestational diabetes, chronic illness, or history of preterm labor/genetic disorder.illness, or history of preterm labor/genetic disorder.

• High risk pregnancies require close monitoring and High risk pregnancies require close monitoring and surveillance.surveillance.

• Preterm births in the United States reached a 20 year high Preterm births in the United States reached a 20 year high of 11.9% in 2001 (National Center for Health Statistics, of 11.9% in 2001 (National Center for Health Statistics, 2002)2002)

• Preterm labor is determined when uterine contractions Preterm labor is determined when uterine contractions cause cervical dilation and effacement.cause cervical dilation and effacement.

Preterm labor cont….Preterm labor cont….

• Best hope for preterm labor is to Best hope for preterm labor is to identify it early and treat it, to identify it early and treat it, to continue the pregnancy.continue the pregnancy.

• This is possible with home care and This is possible with home care and telehealth for patients with high risk telehealth for patients with high risk pregnancy.pregnancy.

Home care Benefits in High Home care Benefits in High Risk PregnancyRisk Pregnancy

• Bed rest and telehealth mointoring are commonly Bed rest and telehealth mointoring are commonly prescribed for patients on home care.prescribed for patients on home care.

• Bed rest is prescribed because physicians believe Bed rest is prescribed because physicians believe it reduces “gravitational stress on the uterus and it reduces “gravitational stress on the uterus and cervix” (Maloni, p. 696).cervix” (Maloni, p. 696).

• Home care provides patients the comfort of their Home care provides patients the comfort of their own home, privacy, and self control over their own home, privacy, and self control over their condition.condition.

• Study’s have shown that hospitalized pregnant Study’s have shown that hospitalized pregnant women have high levels of depression and women have high levels of depression and anxiety than those on home care.anxiety than those on home care.

Virtual Support GroupVirtual Support Group

• Another benefit of home care for high risk Another benefit of home care for high risk patients is the availability of online support patients is the availability of online support groups, which is not available in hospitals.groups, which is not available in hospitals.

• A study on virtual support groups found A study on virtual support groups found that patients at home on bed rest found that patients at home on bed rest found the online support group to be helpful and the online support group to be helpful and alleviate “the isolation of bed rest, and had alleviate “the isolation of bed rest, and had made them fell that they were not alone” made them fell that they were not alone” (Alder & Zarchin, p. 423).(Alder & Zarchin, p. 423).

Home Uterine Activity MonitorHome Uterine Activity Monitor

• Home uterine activity monitoring Home uterine activity monitoring is commonly used in patients at is commonly used in patients at risk for preterm labor.risk for preterm labor.

• It involves the patient applying It involves the patient applying the contraction monitor at home, the contraction monitor at home, 2 to 3 times a day, which 2 to 3 times a day, which transmits data via the telephone transmits data via the telephone line to a 24 hour nurse.line to a 24 hour nurse.

• The nurse contacts the patient The nurse contacts the patient regarding the results of the regarding the results of the monitoring.monitoring.

• Home uterine activity monitoring Home uterine activity monitoring (HUAM) is currently being used (HUAM) is currently being used in Oahu through Matria in Oahu through Matria Healthcare.Healthcare.

Home Uterine Activity Monitor

Non Stress Test Home MonitorNon Stress Test Home Monitor

• Another type of telehealth Another type of telehealth available to patients of high available to patients of high risk pregnancies is the non-risk pregnancies is the non-stress test (NST) home stress test (NST) home monitor.monitor.

• High risk pregnancies are High risk pregnancies are monitored via non stress tests monitored via non stress tests since it provides information on since it provides information on the fetal heart rate which the fetal heart rate which identifies the fetal well-being identifies the fetal well-being during pregnancy.during pregnancy.

• NST’s are usually done daily or NST’s are usually done daily or weekly as early as 26weeks weekly as early as 26weeks gestationgestation

Non Stress Test Home Monitor

NST home monitor cont….NST home monitor cont….

• Patients are sent home with portable monitors Patients are sent home with portable monitors and educated on how to place the monitors to and educated on how to place the monitors to trace their fetal heart rate and contractions.trace their fetal heart rate and contractions.

• Patients are monitored for 20min or more with Patients are monitored for 20min or more with the data transmitted to a 24hour nurse via the the data transmitted to a 24hour nurse via the telephone. The nurse contacts the patient with telephone. The nurse contacts the patient with the results and gives further instructions if the results and gives further instructions if needed.needed.

• NST’s done by patients at home has been proven NST’s done by patients at home has been proven to be accurate, safe and feasible at all gestational to be accurate, safe and feasible at all gestational ages (Kerner et al).ages (Kerner et al).

Other Types of Telehealth for High Other Types of Telehealth for High Risk PregnancyRisk Pregnancy

Blood pressures are Blood pressures are monitored at home monitored at home along with 24hour along with 24hour urine collection for urine collection for patients at risk for patients at risk for pregnancy induced pregnancy induced hypertension.hypertension.

Obstetrical hypertension management Obstetrical diabetes managementProvides blood sugar Provides blood sugar testing and insulin testing and insulin management in patients management in patients with gestational diabetes with gestational diabetes or diabetes (type I or II).or diabetes (type I or II).

All telehealth monitors provide 24 hour nurse contacts and all the data is also transmitted to their primary obstetrician.

Cost EffectivenessCost Effectiveness

• With the cost of health care increasing, looking at alternative With the cost of health care increasing, looking at alternative ways of caring for patients has become popular.ways of caring for patients has become popular.

• Telehealth in high risk pregnancies have proven to be cost Telehealth in high risk pregnancies have proven to be cost effective.effective.

• A study done by Morrison et al (2001) found that “each A study done by Morrison et al (2001) found that “each pregnancy in the telemedicine group cost an average of $7, 225 pregnancy in the telemedicine group cost an average of $7, 225 compared to the $21,684 cost to those who did not receive compared to the $21,684 cost to those who did not receive outpatient services”.outpatient services”.

• Matria Healthcare also states that “for each $1 spent in home Matria Healthcare also states that “for each $1 spent in home preterm management services, $3 to over $5 is saved by preterm management services, $3 to over $5 is saved by reducing antepartum and neonatal nursery days.”reducing antepartum and neonatal nursery days.”

• Cost of telehealth equipment is also a concern, however the Cost of telehealth equipment is also a concern, however the equipment used for high risk pregnancies are portable, equipment used for high risk pregnancies are portable, lightweight, and inexpensive (Kerner et al).lightweight, and inexpensive (Kerner et al).

ConclusionConclusion• Providing home care with telehealth technology allows high Providing home care with telehealth technology allows high

risk pregnant women to be cared for in the comfort and risk pregnant women to be cared for in the comfort and privacy of their own home in a safe and manageable way.privacy of their own home in a safe and manageable way.

• Nurses need to be aware of current technology available for Nurses need to be aware of current technology available for high risk pregnant women who can receive home care.high risk pregnant women who can receive home care.

• Nurses need to educate patients on new technology available.Nurses need to educate patients on new technology available.

• ““Nurses have the opportunity to shape the future of health-Nurses have the opportunity to shape the future of health-care service delivery and encourage programs that are not care service delivery and encourage programs that are not only cost-effective but also more responsive to consumer only cost-effective but also more responsive to consumer needs” (Heaman et al, p. 712).needs” (Heaman et al, p. 712).

The EndThe End

Just some humor, with all the new programs I was working with (like developing my own webpage) it was all definitely a challenge.