Asynchronous telemedicine with ultrasound: Improving maternal health in developing countries

The UN selected improving maternal health as Millennium Development Goal #5. To achieve this goal, Maternal Mortality Ratio (MMR), the number of maternal deaths per 100,000 live births, has to be reduced substantially. In Sub-Saharan Africa, MMR is about 100 times higher than that in developed countries. The objective of this study was to assess the feasibility of an electronic medicine system in facilitating consultation and collaboration between specialists in maternal-fetal health and midwives new to obstetric ultrasound. We developed a web-based asynchronous telemedicine system, which consisted of a portable US machine a laptop, and a server. The system was deployed in late 2008 and evaluated with a midwife in South Africa and three OB/GYN specialists in the U.S. Asynchronous communication between the midwife and OB/GYN specialists consisted of direct annotation on US images using colored lines, shapes and free text associated with each case. During the study period, the system received 114 review requests on 91 women with a total of 704 US images with 1,166 annotations. Specialists noted 25 ¿high-risk¿ conditions, which included breech presentation (9 cases), fetal malformation and growth restriction (9), gestational diabetes (3), placenta previa (2), multiple gestation (1), and intra-uterine infection (1). Feedback from all the users indicated satisfaction with system reliability and operation. Our findings suggest that 1) it is technically feasible to expand routine availability of prenatal ultrasound to populations with restricted access to this service and 2) a midwife can be successfully coached in obstetric ultrasound acquisition and interpretation skills via a web-based asynchronous educative system. We believe that ultrasound imaging could play a major role in reducing the maternal mortality in developing countries.