Telehealth for High-Risk Pregnancies in the Setting of the COVID-19 Pandemic
Telehealth for High-Risk Pregnancies in the Setting of the COVID-19 Pandemic
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DOI：
10.1055/s-0040-1712121
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发表时间：
2020-06-01
影响因子：
2
通讯作者：
Friedman, Alexander M.
中科院分区：
文献类型：
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作者：
Aziz, Aleha;Zork, Noelia;Friedman, Alexander M.
随着纽约市成为2019年新型冠状病毒病（COVID-19）大流行的国际震中，远程医疗迅速融入了曼哈顿的学术医院系统哥伦比亚大学欧文医疗中心的产前护理。实施的目标是将亲自进行的产前筛查、监测和检查合并为更少的亲自就诊，同时通过远程保健虚拟就诊保持患者获得持续产前护理和专科咨询的机会。这一变化的理由是尽量减少患者旅行，从而减少COVID-19暴露的风险。由于很大一部分产科病人有潜在的医疗或胎儿状况，使他们在增加风险的不良后果，产前护理远程保健方案量身定制，以增加监测和/或咨询。在将远程保健纳入高危患者产前护理的基础上，对以下情况、临床情景和服务提出了具体建议：（1）妊娠期高血压疾病，包括先兆子痫、妊娠期高血压和慢性高血压;（2）妊娠前和妊娠期糖尿病;（3）孕产妇心血管疾病;（4）孕产妇神经系统疾病;（5）早产史和不良产科史，包括先前死胎;（6）胎儿状况，如宫内生长受限、先天性异常和多胎妊娠，包括单绒毛膜胎盘;（7）遗传咨询;（8）心理健康服务;（9）产科麻醉咨询;和（10）产后护理。虽然远程医疗虚拟访问不能完全取代产前护理期间的面对面接触，但它们确实提供了一种减少潜在患者和提供者接触COVID-19的手段，同时提供综合的面对面测试和服务。
As New York City became an international epicenter of the novel coronavirus disease 2019 (COVID-19) pandemic, telehealth was rapidly integrated into prenatal care at Columbia University Irving Medical Center, an academic hospital system in Manhattan. Goals of implementation were to consolidate in-person prenatal screening, surveillance, and examinations into fewer in-person visits while maintaining patient access to ongoing antenatal care and subspecialty consultations via telehealth virtual visits. The rationale for this change was to minimize patient travel and thus risk for COVID-19 exposure. Because a large portion of obstetric patients had underlying medical or fetal conditions placing them at increased risk for adverse outcomes, prenatal care telehealth regimens were tailored for increased surveillance and/or counseling. Based on the incorporation of telehealth into prenatal care for high-risk patients, specific recommendations are made for the following conditions, clinical scenarios, and services: (1) hypertensive disorders of pregnancy including preeclampsia, gestational hypertension, and chronic hypertension; (2) pregestational and gestational diabetes mellitus; (3) maternal cardiovascular disease; (4) maternal neurologic conditions; (5) history of preterm birth and poor obstetrical history including prior stillbirth; (6) fetal conditions such as intrauterine growth restriction, congenital anomalies, and multiple gestations including monochorionic placentation; (7) genetic counseling; (8) mental health services; (9) obstetric anesthesia consultations; and (10) postpartum care. While telehealth virtual visits do not fully replace in-person encounters during prenatal care, they do offer a means of reducing potential patient and provider exposure to COVID-19 while providing consolidated in-person testing and services.