Application of Remote Fetal Heart Rate Monitoring Based on Internet in Late Pregnancy During the COVID-19 Pandemic

doi:10.21203/rs.3.rs-1599526/v2

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Application of Remote Fetal Heart Rate Monitoring Based on Internet in Late Pregnancy During the COVID-19 Pandemic

https://doi.org/10.21203/rs.3.rs-1599526/v2

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Objective：To evaluate the consistency of pregnancy outcomes and related clinical monitoring indicators in high and low risk group under two different monitoring methods during COVID-19 pandemic.Methods：760 cases of late pregnant women admitted to our hospital from March 2020 to February 2021 were selected for this study. They were randomly divided into control group (n = 380) and observation group (n = 380). Observation group the fetus was monitored remotely at home，while the control group went to the hospital for fetal heart monitoring.To evaluate the consistency of pregnancy outcomes and related clinical monitoring indicators in different groups under two different monitoring .Results:It was found that there was no statistically significant difference between the two groups in terms of pregnancy outcome (including mode of delivery, postpartum hemorrhage, etc.) and neonatal outcome (including preterm birth rate, neonatal weight, neonatal Apgar score, etc.) (p>0.05). It should also be noted that the difference in EPDS score results between the two groups was statistically significant (p<0.05) . Meanwhile, there was a statistically significant difference in the total cost of labor and delivery between two groups (p<0.05) and total time spent on labor and delivery between the two groups(p<0.05).Conclusions:Remote Fetal Heart Rate Monitoring Based on Internet is an innovative, acceptable, and effective reduced-frequency prenatal examination model. Compared to routine prenatal examination, Remote Fetal Heart Rate Monitoring Based on Internet resulted in higher patient satisfaction and lower prenatal stress. Besides, Remote Fetal Heart Rate Monitoring Based on Internet compared with the traditional fetal heart monitoring does not affect the pregnancy outcomes of pregnant women with different risk factors, maternal accept degree is high, and to reduce the medical resources pressure. It is an effective and feasible way for self-monitoring of pregnancies in late pregnancy during the pandemic of COVID-19 and is worthy of clinical application.

COVID-19

prenatal examination

remote fetal heart monitoring

pregnancy outcome

neonatal outcome

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is rapidly spreading across the world to cause thousands of mortalities each day.Based on the latest guidelines from Chinese health authorities,there are 3 main transmission routes for the COVID-19 virus in humans ，namely direct contact, aerosol, and droplets[1].The risk of viral transmission is higher in the case of short contact with a symptomatic person than with an asymptomatic person[2] .SARS-CoV-2 is also transmitted when a person touches the surfaces contaminated with the virus [3].Pregnant women is a susceptible population for 2019-nCoV and is more likely to develop complications and even progress to severe disease;Besides,Major stressors(e.g., health crises and natural disasters) can increase pre-natal stress and make pregnant women particularly vulner-able [4,5]. According to the review by Salari et al. [6], women during the pandemicare at increased risk of developing depression, anxiety and stress. Social isolation makes it difficult to interact with family and friends [7]; hospital visitation restrictions [8] and fear of the possibility of intrauterine transmission of COVID-19 to the fetus [9] pose challenges to the mental health of mothers-to-be .It is reported that neonates from COVID-19−infected mothers are have tested positive for SARS-CoV-2 shortly following delivery[10]and evidence of SARS-CoV-2 has been detected in the placenta of COVID-19 positive mothers[11].The results of many studies on the mother-to-child transmission of SARS-CoV-2 are inconclusive; Vertical transmission of SARS-CoV-2 is possible but is rare [12]. Current studies indicate that the probability of vertical SARS-CoV-2 transmission from mother to newborn ranges from 3% [12] to 8% [13]. During the Novel Coronavirus pandemic, how to reduce pregnant women's exposure to crowded public places while at the same time enabling pregnant women to receive the necessary pregnancy monitoring is of vital importance for health care and prevention and control during the third trimester of pregnancy.

In the 21st century, Internet + medical treatment is a new stage and inevitable trend of medical development.The rapid adoption of telemedicine over the COVID-19 global pandemic has also seen a surge in consumer demand for technologies to support treatment from home[14].As a new routine maternity and fetal monitoring, remote fetal heart monitoring can not be limited by time and space, greatly reducing the risk of external infection of pregnant women during COVID-19.The popularity of electronic fetal heart monitoring system is of great significance for early detection of fetal abnormalities and prevention of fetal damage to achieve eugenics.As an important tool for monitoring intrauterine conditions and fetal reserve capacity, fetal heart monitoring in late pregnancy is widely used in clinical practice and has effectively reduced the incidence of adverse pregnancy outcomes[15]. Internet-related technologies have rapidly developed and started to impact on traditional medical practices, and it has become a mainstream trend to combine wireless communication technology with "cloud service" technology and electronic fetal heart monitoring.

This article mainly discusses the Clinical application value of Remote Fetal Heart Rate Monitoring Based on Internet in Late Pregnancy During the COVID-19 Epidemic.The aim is to build a new and reliable Internet home health management system to reduce the risk of out-of-home infection of pregnant women during the COVID-19 outbreak.

1.1 Subjects

(1) Inclusion criteria: who received prenatal examination from the obstetric clinic of our hospital the epidemic period of novel coronavirus on March 2020 to February 2021, and low-risk pregnant women who received prenatal examination at 34 weeks (all pregnancy test indicators were within the normal range, without pregnancy complications ) were enrolled. High-risk pregnant women (combined with gestational diabetes, hypertension, maternal immune disorders, fetal growth restriction, history of adverse pregnancy and delivery, or the presence of factors considered clinically high-risk) were enrolled at 32 weeks. age 18-45 years.

(2) Exclusion criteria: confirmed twin pregnancy, fetal malposition, fetal arrhythmia, pregnant women with psychiatric disorders, systemic diseases and their critical illnesses that prevented them from completing monitoring; inability to use the monitoring system properly and automatic withdrawal of pregnant women during the study.

(3) Grouping:The subjects were randomly divided into two groups by random number method. The control group was routinely examined.The observation group underwent remote EFM. There was no statistically significant difference (P > 0.05) between the two groups in terms of general information such as age, gestational age, number of pregnancies and deliveries, education level, and high-risk factors, so they were comparable.

1.2 Equipment and methods

The control group performed fetal movement count at home by themselves and went to the hospital regularly for routine prenatal examination, and went to the hospital immediately for prenatal fetal heart monitoring non-stress test (NST) when abnormal fetal heartbeat on auscultation, abnormal fetal movement, and time beyond the expected delivery date. In the control group, an ultrasonic Doppler EFM instrument (model: eFM-30) was used for fetal heart monitoring.

The observation group used the “October baby remote EFM system”(produced by Shenzhen Lekangning Technology Co., LTD.)rented by the hospital for monitoring, pregnant women used the system to monitor themselves at home, and transmitted the measured data signals to the system's tag-end server "cloud platform" through the cell phone APP, the tag-end server will AI intelligent interpretation of the monitoring results, and timely send SMS messages to notify the medical staff to review the data. The server will then send the doctor's diagnosis to the pregnant woman's cell phone via SMS. If there is any abnormality, online guidance and question & answer(Q&A) will be given to pregnant women in time. The experimental group requires pregnant women to monitor (including remote fetal heart rate monitoring, blood pressure, blood glucose and weight) ≥ 2 times per week, and the app reports the results and provides internet consultation guidance in the first time.

1.3 Monitoring items and methods

1.3.1 Fetal movement and fetal heart monitoring

(1) Abnormal fetal movement: the number of fetal movement <10 times/2h or 50% increase or decrease compared with the previous 3h is abnormal ;

(2) Abnormal fetal heart rate: fetal heart rate >160 beats/min or <110 beats/min .

(3) NST abnormalities: ①baseline abnormalities, fetal heart rate >160 beats/min or <110 beats/min. ②baseline variability abnormalities: baseline variability 6-25 beats/min is normal variability, amplitude fluctuations disappear as variability absence, <5 beats/min is minor variability, >25 beats/min is significant variability. ③ Moderate to severe variability deceleration: There is no fixed relationship between deceleration and contractions, baseline rate increases, amplitude decrease increases, fetal heart rate deceleration > 60 beats/min, duration > 60s. ④ Acceleration abnormality: 20min <1 acceleration more than 15 beats/min, duration 15s[16].

Monitoring method: the test group monitored the fetal movement count at a fixed time every morning, noon and night, and self-monitored once a day at a fixed time. Pregnant women are required to empty their bladder when performing fetal heart monitoring, avoid monitoring after exercise, avoid fasting and starvation, half an hour after meal is appropriate, and taking the left side lying position is preferred. Pregnant women are required to count fetal movement within the specified time, listen to fetal heartbeat 3 times for 20min each time, if pregnant women feel abnormal fetal movement or other discomfort (such as panic, poor breathing, etc.), perform fetal heart monitoring in time, the time can be extended in abnormal situation. When abnormal results of fetal heartbeat or fetal movement are found, contact the hospital and perform fetal umbilical blood flow monitoring and ultrasound examination in time to observe and treat the abnormal condition.

1.3.2 Blood pressure

Hypertension in pregnancy:

Inclusion and exclusion criteria for out-of-hospital blood pressure monitoring during pregnancy：

Inclusion criteria：Refer to the Guidelines for Self-monitoring of Blood Pressure in pregnancy issued by the Royal Society of Obstetricians and Gynecologists (RCOG) in 2020[17].

Exclusion criteria: Required hospitalized pregnant women such as severe hypertension and preeclampsia[17].

(1) Systolic blood pressure≧140mmHg and/or diastolic blood pressure≧90mmHg, or blood pressure is elevated≧25/15mmHg compared with pre-pregnancy or early pregnancy, and blood pressure is measured at least twice, 6 hours apart. Severe pre-eclampsia blood pressure is systolic blood pressure≧160mmHg and/or diastolic blood pressure≧110mmHg.

(2) Dynamic 24h mean systolic blood pressure (24hSBP)≧130 and/or 24h mean diastolic blood pressure (24hDBP)≧80mmHg, daytime mean systolic blood pressure (dSBP)≧135 and/or daytime mean diastolic blood pressure (dDBP)≧85mmHg, nighttime mean systolic blood pressure (nSBP) ≧ 120 and/or nighttime mean diastolic blood pressure (nDBP) ≧ 70mmHg[18].Blood pressure monitoring method: pregnant women in the test group with blood pressure cuff to the left upper elbow 2cm-3cm brachial artery; gestational hypertension for 24 hours a week fixed day, 6:00-22:00, night 22:00-6:00,24hSBP, 24hDBP, dSBP, dDBP, nSBP, nDBP.All the measurement results are input into the remote monitoring system, the diastolic blood pressure is less than 40mmHg, the systolic blood pressure is greater than 220mmHg is invalid, and the measured data is greater than 80% of the total is valid.The background server analyzes the blood pressure in time, sends the data to the medical staff for review, and if there is any abnormality, give the pregnant women online guidance and answer questions in time.

1.3.3 blood glucose

Gestational diabetes mellitus (GDM):

(1)75g oral glucose tolerance test (OGTT) 1, 2h after taking sugar, 3 blood glucose values should be less than 5.1, 10.0, 8.5mmol/L (92, 180, 153mg/dl) respectively.

(2) fasting plasma glucose (FPG) ≧ 5.1mmol/L, directly diagnosed as GDM, without OGTT; FPG <4.4mmol/L (80mg/dl), the possibility of GDM is very small, without OGTT; FPG ≧ 4.4mmol/L and <5.1mmol/L

(3) glycated hemoglobin HbA1c≧6.5% [19-20].

Monitoring method: the pregnant women in the test group monitored fasting plasma glucose once a week at a fixed time; among them, the pregnant women with gestational diabetes mellitus monitored blood glucose at seven time points: fasting, two hours after breakfast, two hours before lunch, two hours after lunch, two hours before dinner, two hours after dinner and before bedtime at a fixed time day a week. If abnormal blood glucose levels are found, the hospital will be contacted in time for the appropriate online consultation and the appropriate observation and treatment.

1.3.4 weight

In women with normal pre-pregnancy Body Mass Index (BMI) (18.5~24.9 kg/m2), the average weight gain during pregnancy is 12.5 kg in singleton pregnancies, but the rate of weight gain varies during different periods of pregnancy. In 2009, the Institute of Medicine (IOM) recommended that the range of gestational weight gain (GWG) during pregnancy be determined according to the pre-pregnancy BMI of the pregnant woman, The IOM recommended that the appropriate range of GWG for pregnant women with pre-pregnancy BMI less than 18.5kg/m2, 18.5-24.9kg/m2, 25.0-29.9kg/m2 and 30.0kg/m2 or more should be 12.5-18kg, 11.5-16kg, 7-11.5kg and 5-9kg respectively[21-22].

Monitoring method: the test group will record their weight at least twice a week, calculate the body mass index and mark it in the weight management scale. Then compare it with the weight gain recommendation for pregnant women issued by IOM according to their pregnancy weeks, and transmit the data to the "cloud platform". Finally, the back-end server will intelligently give corresponding nutritional guidance according to their weight to control the weight of pregnant women within a reasonable range.

1.3.5 Online multidisciplinary team (MDT)

A comprehensive and personalized approach to maternal management during pregnancy, labor and delivery and postpartum must be implemented. Anhui Maternal and Child Health Hospital, as the Anhui Province Critical Maternity Treatment Center, is the first in the province to implement a seamless MDT model for outpatient and inpatient care in maternal and child health hospitals, providing scientific, continuous and objective diagnosis and treatment services for pregnancy assessment and delivery services during childbirth.

We firstly based on basic conditions, pregnancy abnormalities and delivery, and then based on environmental and social factors, especially pregnancy complications, to establish a high-risk maternal score for pregnant women in the control and observation groups. According to the level of high risk, the risk factors can be divided into 5 points, 10 points, 20 points factors to assess. Meanwhile, according to the high risk of maternal risk degree, maternal of high risk will be divided into green, yellow, orange, and red, each grade given different check, follow-up and intervention. In the control group, the MDT evaluation team established by the outpatient department of our hospital (composed of experts in high-risk obstetrics outpatient department, experts in gynecology, pediatrics, internal medicine, and surgery) conducted a preliminary assessment on the person with the orange and red markers of high-risk pregnant women, and decided whether to start the MDT procedure. The hospital is equipped with MDT clinic at fixed time and place to conduct intervention and diagnosis and treatment for pregnant women. First-time pregnant women are treated through the hospital MDT assessment team outpatient service, established a family health management system to identify high-risk patients for online MDT specialist diagnosis and treatment, and collected information about high-risk maternal screening at home in time. By online experts on the MDT, high-risk pregnant women will be supervised at any time for intervention, guidance and preliminary treatment, prompt hospitalization if necessary.

1.3.6 Psychosomatic assessment criteria

The subjects were grouped according to a random numbered table at enrollment, the general, social, postnatal depression risk factors, the Edinburgh Postnatal Depression Scale (EPDS) was used to measure 3-7 d postpartum.10 items on the EPDS, each with a 4-point scale (0-3), and a total score of > 9 are considered suspicious for postnatal depression. receive psychological counseling, and ≥13 was considered as having depressive symptoms [23-24].

1.4 Pregnancy outcome analysis

The mode of delivery was compared between the two groups of pregnant women, including the rate of vaginal assisted delivery, vaginal delivery, cesarean delivery, and surgical intervention.

1.5 Neonatal outcome analysis

(1) Amniotic fluid contamination: The grading method included brownish-yellow color of amniotic fluid, dense, with particles indicating degree III; yellowish-green or dark green color of amniotic fluid indicating degree II; yellowish or light green color of amniotic fluid indicating degree I.

(2) Neonatal asphyxia: Apgar score was applied to assess the physical condition of neonates in both groups, including heart rate, muscle tone, respiration, skin color, reflexes, movement and other items, with a score of 10 out of 10. The scores included 8-10 (normal), 4-7 (mild asphyxia), and 0-3 (severe asphyxia).

(3) Umbilical cord abnormality: the umbilical cord is too short, tangled, twisted.

(4) Weight: including low weight babies: newborns weighing <2500g at birth; huge babies: fetuses weighing 4000g or more.

(5) Preterm birth: those terminated at >28 weeks to <37 weeks gestation.

(6) Neonatal ischemic-hypoxic encephalopathy (HIE).

(7) Neonatal pneumonia.

(8) Transfer rate to pediatrics.

1.6 Statistical methods

All data were statistically analyzed by SPSS 22.0 software, and the measurement data were expressed as x ± s, and t-test was used for comparative analysis between groups; the count data were expressed as rate (%), and χ2 test was used for comparative analysis between groups, and P < 0.05 was considered a statistically significant difference.

Our study inclusion 760 puerpera after a gestational age 32 weeks in Anhui Medical University Affiliated Maternity and Child Healthcare Hospital (March 2020—February 2021).The subjects were randomly divided into control group (n = 380) and observation group (n = 380). Observation group the fetus was monitored remotely at home，while the control group went to the hospital for fetal heart monitoring.The general clinical characteristics of the two groups, including age, pregnancy and childbirth times, adverse maternal and perinatal outcomes, height, weight, blood pressure, fasting plasma glucose, postprandial glucose, thyroid function, cholyglycine and gestational age were not statistically different by t-test (p>0.05). (Table1)

The low-risk group and the high-risk group were further compared, the clinical data of the two groups (p>0.05)(Table1), pregnancy outcome (including delivery method, postpartum hemorrhage, etc.) (Table2) and neonatal outcome (premature birth rate, newborn Baby weight, Apgar score of newborns, etc.) (p>0.05)(Table3), there was no statistical difference. It is worth noting that the difference in the scores of EPDS scores between the two groups was statistically significant (p<0.05)(Table4). At the same time, statistically difference was also observed in the number of maternity examinations. The remote fetal monitoring group went to the hospital for fewer maternity examinations, compared to the traditional group. In addition, there was a statistically significant difference in maternity expenses and total time consumption between two groups (p<0.05) (Table5).

Currently, the latest hazard to global health is the persistent outbreak of the respiratory disease that was COVID-19[ 25]. It was rapidly shown to be caused by a novel coronavirus that is structurally related to the virus that causes severe acute respiratory syndrome (SARS). Other coronaviral infections such as the SARS-CoV-1 and Middle East respiratory syndrome (MERS) increased risks for adverse outcomes for the fetus and/or newborns including miscarriages , preterm birth, fetal distress, and FGR with SARS-CoV-1 infection during the second and third trimesters[26-27]. Recent evidence indicates Covid-19 may also cause more serious complications in pregnant women [28-32]. As global continues to be affected by the COVID-19 pandemic, health care systems have instantly adapted to maintain access to care while providing recommended social distancing. In the field of obstetrics, remote prenatal examination quickly gained popularity, because postponing outpatient treatment is not an available option.

Prenatal fetal monitoring is a dynamic, real-time prenatal measurement of fetal growth and health. It is an early warning method for fetal growth and development and health status. In 30% of pregnancies, the umbilical cord is wrapped around the fetus, causing intrauterine hypoxia. Though Internet-based home health management systems were implemented within our prenatal system in response to the COVID-19 pandemic, we have discovered a silver lining within this public health emergency. Internet-based home health management systems were a quick and safe solution, maintaining quality of care with low user burden. The new generation of remote fetal heart rate monitoring (RFHRM) system consists of monitoring hardware, smart phone APP and physician system (information analysis center)[33]. The monitoring hardware is the attached CWFM1 microfetal heart monitor, which is designed with 9-chip medical Doppler ultrasound probe, with a wide beam signal range and 1MHz ultrasound frequency, equipped with Bluetooth, which can transmit digital signals to the smartphone APP. The fetal movement information is collected by clicking on the smartphone APP interface, and data upload and result feedback are realized through mobile Internet [34]. It realized that pregnant women do not need to visit the hospital, saving time and economic costs, and at the same time, they can monitor intrauterine fetal abnormalities at home in a timely manner and transmit to the hospital monitoring system in case of abnormalities to obtain feedback from doctors and diagnosis and treatment plans for timely treatment. Hospitals can also perform continuous, systematic and complete file management to provide a full range of health management services for pregnant women.

In this study, we took the mothers registered in our hospital in the late pregnancy period of the COVID-19 epidemic as the subjects, and the mothers who had traditional examination as the control group and the mothers who received "Remote Fetal Heart Rate Monitoring Based on Internet" as the experimental group. We analyzed whether there were differences in pregnancy outcome, delivery mode and neonatal outcome between the two modes of delivery, and explored the safety of RFHRM in late pregnancy delivery during the epidemic period of the COVID-19. It is hoped that the "Remote Fetal Heart Rate Monitoring Based on Internet" can be an alternative to the traditional delivery model to ensure that pregnant women receive the necessary pregnancy monitoring in order to reduce the number of visits to medical institutions for delivery during late pregnancy and achieve effective maternal protection during the Covid-19 epidemic.

We recognize that this study has some limitations.While the EPDS score and anhedonia, anxiety and depression subscales score were used to study psychological-emotional distress in mothers giving birth during the COVID-19 pandemic, we did not use specific criteria defined in the medical literature to confirm whether our sample had postpartum depression.However, this should not invalidate the results, as the general demographic variables were similar between the groups.Moreover, nearly 11.3% of mothers in the traditional care group had higher global EPDS scores than 12, which may lead to a higher risk of postpartum depression, and a deeper analysis of the three subscales highlights the additional value of EPDS and facilitates a more accurate assessment of the various negative psychological problems raised in pregnant women during the COVID-19 pandemic.Anhedonia and depression scores were significantly higher in the traditional monitoring group.Furthermore, it is well documented that if the EPDS total score is between 0 and 30, the higher the score, the higher the severity of the corresponding depressive symptoms.Finally, the current literature on this subject is limited, and, therefore, this study makes an important contribution to understanding the impact of natural infectious disasters on the mental health of pregnant women.

From the above statistic analysis, it was concluded that there was no difference between the Internet-based home health management systems group and the routine preconception examination group in terms of pregnancy outcome and neonatal outcome, indicating that this new model of preconception examination is safe when applied clinically and also helps to relieve pregnancy stress and reduce the occurrence of gestation period and postpartum depression and anxiety. It is vital to note that the total duration of maternity visits and the number of visits to health facilities for maternity examinations and exposure during late pregnancy can be effectively reduced during a new coronavirus pneumonia epidemic or a major outbreak without causing a difference in the total cost of maternity examinations.

In conclusion, remote fetal heart monitoring has the advantages for pregnant women with different risk pregnancy, such as improving perinatal outcomes, shortening their waiting or medical treatment time, reducing human and material resources consumption in hospitals, optimizing service quality, and providing remote professional interpretation.At the same time, the remote fetal supervision mode is not limited by time and space. Through the "Internet + medical" mode, fetal intrauterine abnormalities can be found in time, reduce the incidence of fetal distress, extend the gestational week, reduce the rate of neonatal mortality rate, reduce the incidence of premature birth, and improve the prognosis of mother and child.Especially during the COVID-19 period, remote fetal heart monitoring is an effective supplement to traditional prenatal testing, which can well monitor different risk pregnant women at home, improve perinatal outcomes, and not increase the rate of cesarean section, which has clinical application value.

Funding sources:

This work was supported by Hefei municipal Key Research Project of Novel Coronavirus Pneumonia Control and Prevention (Grant No. HWK2020zd008).

Declaration of interest statement:

The authors declare no conflict of interest to disclose.

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Table 1. Comparison of general characteristics between traditional fetal monitoring group and remote fetal monitoring group

Characteristics	Remote group	Traditional group	t	p value
Number
Total	380	380	—	—
Low-Risk Pregnancy	175	192	—	—
High-Risk Pregnancy	205	188	—	—
Age(y)
Total	29.87	29.68	0.680	0.497
Low-Risk Pregnancy	29.59	29.34	0.614	0.539
High-Risk Pregnancy	30.11	30.01	0.105	0.917
Height(cm)
Total	161.96	162.60	-1.679	0.094
Low-Risk Pregnancy	161.80	162.80	-1.965	0.051
High-Risk Pregnancy	162.09	162.39	-0.530	0.597
Weight(kg)
Total	71.37	70.48	1.398	0.162
Low-Risk Pregnancy	71.25	71.60	-0.403	0.687
High-Risk Pregnancy	71.48	69.44	2.209	0.028
Gestational Age(weeks)
Total	39.46	39.43	0.234	0.815
Low-Risk Pregnancy	39.46	39.44	0.192	0.848
High-Risk Pregnancy	39.457	39.437	0.180	0.857
Systolic pressure(mmHg)
Total	117.95	119.03	-1.124	0.261
Low-Risk Pregnancy	118.09	118.17	-0.057	0.955
High-Risk Pregnancy	117.83	119.80	-1.408	0.160
Diastolic pressure(mmHg)
Total	75.48	74.67	1.345	0.179
Low-Risk Pregnancy	74.92	75.91	-1.102	0.271
High-Risk Pregnancy	75.95	73.43	3.251	0.001
Fasting plasma glucose(mmol/L)
Total	4.73	4.69	1.308	0.191
Low-Risk Pregnancy	4.72	4.71	0.083	0.934
High-Risk Pregnancy	4.73	4.66	1.857	0.064
Postprandial blood glucose(1h) (mmol/L)
Total	7.74	7.69	0.445	0.658
Low-Risk Pregnancy	7.78	7.77	0.023	0.982
High-Risk Pregnancy	7.71	7.64	0.580	0.563
Postprandial blood glucose(2h) (mmol/L)
Total	6.38	6.40	-0.256	0.791
Low-Risk Pregnancy	6.38	6.42	-0.347	0.729
High-Risk Pregnancy	6.38	6.39	-0.144	0.886
TSH (mIU/L)
Total	1.59	1.53	1.171	0.242
Low-Risk Pregnancy	1.55	1.50	0.795	0.433
High-Risk Pregnancy	1.63	1.56	0.803	0.423
Cholyglycine (mg/L)
Total	1.47	1.16	1.081	0.280
Low-Risk Pregnancy	1.16	1.20	-0.343	0.731
High-Risk Pregnancy	1.74	1.14	1.133	0.258

There were no significant differences between two groups in the general clinical characteristics except for weight and diastolic blood pressure in high risk group.(P < 0.05).

Table2.Comparison of pregnancy outcome between traditional fetal monitoring group and remote fetal monitoring group

pregnancy outcome	Remote group	Traditional group		X²	P-value
Premature birth rate (%)
Total	9.24(22/380)		3.68(14/380)	1.866		0.172
Low-Risk Pregnancy	6.29(11/175)		4.17(8/192)	0.837		0.360
High-Risk Pregnancy	5.37(11/205)		3.19(6/188)	1.120		0.290
Postpartum hemorrhage rate (%)
Total	7.36(28/380)		9.47(36/380)	1.092		0.296
Low-Risk Pregnancy	6.29(11/175)		8.33(16/192)	0.563		0.453
High-Risk Pregnancy	8.29(17/205)		10.64(20/188)	0.633		0.426
Cesarean section rate(%)
Total	56.05(213/380)		61.05(232/380)	1.842		0.175
Low-Risk Pregnancy	57.71(101/175)		66.15(127/192)	2.766		0.096
High-Risk Pregnancy	54.63(112/205)		55.85(105/188)	0.633		0.426

There were no significant differences between two groups in the pregnancy outcome (P >0.05).

Table3.Comparison of neonatal outcome between traditional fetal monitoring group and remote fetal monitoring group

Neonatal outcome	Remote group	Traditional group	t	P-value
Weight of newborn (g)
Total	3275.73±436.86	3253.21±433.78	0.713	0.476
Low-Risk Pregnancy	3266.86±434.31	3251.65±429.69	0.337	0.736
High-Risk Pregnancy	3283.31±439.95	3256.70±438.75	-0.600	0.549
Apgar(1 min)
Total	8.97	8.94	1.139	0.255
Low-Risk Pregnancy	8.97	8.93	1.080	0.281
High-Risk Pregnancy	8.97	8.95	0.526	0.599
Apgar(5 min)
Total	9.99	9.98	1.098	0.272
Low-Risk Pregnancy	9.99	9.97	0.058	0.559
High-Risk Pregnancy	9.99	9.98	1.039	0.300

There were no significant differences between two groups in the neonatal outcome(P >0.05).

Table4. Edinburgh Postnatal Depression Scale, anhedonia, anxiety, and depression subscale scores of mothers who gave birth between March 2020—February 2021 (Remote Group) and mothers who gave birth during the same period (Traditional Group).

scale	Remote group	Traditional group	t	P-value
EPDS total score
Total	5.11±3.00	7.74±3.76	-10.653	0.000
Low-Risk Pregnancy	4.89±2.96	8.03±4.03	-8.545	0.000
High-Risk Pregnancy	5.29±3.02	7.37±3.47	-6.311	0.001
EPDS subscale analysis
Anhedonia
Total	1.79±1.22	2.61±1.55	-8.018	0.000
Low-Risk Pregnancy	1.67±1.04	2.64±1.66	-6.783	0.000
High-Risk Pregnancy	1.89±1.34	2.63±1.71	-4.741	0.000
Anxiety
Total	1.69±1.31	1.51±1.12	-9.717	0.000
Low-Risk Pregnancy	1.60±1.14	2.76±1.61	-7.974	0.000
High-Risk Pregnancy	1.65±1.27	2.43±1.47	-5.606	0.000
Depression
Total	1.02±0.83	2.48±1.73	-7.109	0.000
Low-Risk Pregnancy	1.62±1.41	2.63±1.76	-6.068	0.000
High-Risk Pregnancy	1.75±1.21	2.31±1.69	-3.721	0.000
EPDS global score >12
Total	6(1.6)	51(13.4)	-6.446	0.000
Low-Risk Pregnancy	6(1.7)	32(16.7)	-5.209	0.000
High-Risk Pregnancy	3(1.4)	19(10.1)	-3.664	0.001

Abbreviation: EPDS, Edinburgh Postnatal Depression Scale.

EPDS subscale analysis showed that mean scores for anhedonia, anxiety, and depression were all higher in the traditional group compared with the remote group(p<0.05).

Table 5 .Comparison of maternity expenses and total time consumption between traditional fetal monitoring group and remote fetal monitoring group

	Remote group	Traditional group	t	P-value
Maternity expenses
Total	2241.56±432.85	2789.17±413.98	-17.823	0.000
Low-Risk Pregnancy	2226.25±427.79	2779.91±402.48	-12.773	0.000
High-Risk Pregnancy	2254.62±437.75	2797.32±427.34	-12.417	0.000
Total time consumption
Total	17.59±1.73	40.53±2.86	-132.811	0.000
Low-Risk Pregnancy	17.69±1.79	40.49±2.95	-90.359	0.000
High-Risk Pregnancy	17.51±1.67	40.56±2.84	-97.086	0.000

There were a statistically significant differences between traditional fetal monitoring group and remote fetal monitoring group in the maternity expenses and total time consumption (P <0.05).

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Application of Remote Fetal Heart Rate Monitoring Based on Internet in Late Pregnancy During the COVID-19 Pandemic

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Abstract

Introduction

Materials And Methods

1.1 Subjects

1.2 Equipment and methods

1.3 Monitoring items and methods

1.3.1 Fetal movement and fetal heart monitoring

1.3.2 Blood pressure

1.3.3 blood glucose

1.3.4 weight

1.3.5 Online multidisciplinary team (MDT)

1.3.6 Psychosomatic assessment criteria

1.4 Pregnancy outcome analysis

1.5 Neonatal outcome analysis

Results

Discussion

Declarations

Funding sources:

Declaration of interest statement:

References

Tables

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