title: Improving perinatal care in the rural regions worldwide by wireless enabled antepartum fetal monitoring: a demonstration project.
abstract: Background. Fetal and neonatal morbidity and mortality are significant problems in developing countries; remote maternal-fetal monitoring offers promise in addressing this challenge. The Gary and Mary West Health Institute and the Instituto Carlos Slim de la Salud conducted a demonstration project of wirelessly enabled antepartum maternal-fetal monitoring in the state of Yucatán, Mexico, to assess whether there were any fundamental barriers preventing deployment and use. Methods. Following informed consent, high-risk pregnant women at 27-29 weeks of gestation at the Chemax primary clinic participated in remote maternal-fetal monitoring. Study participants were randomized to receive either prototype wireless monitoring or standard-of-care. Feasibility was evaluated by assessing technical aspects of performance, adherence to monitoring appointments, and response to recommendations. Results. Data were collected from 153 high-risk pregnant indigenous Mayan women receiving either remote monitoring (n = 74) or usual standard-of-care (n = 79). Remote monitoring resulted in markedly increased adherence (94.3% versus 45.1%). Health outcomes were not statistically different in the two groups. Conclusions. Remote maternal-fetal monitoring is feasible in resource-constrained environments and can improve maternal compliance for monitoring sessions. Improvement in maternal-fetal health outcomes requires integration of such technology into sociocultural context and addressing logistical challenges of access to appropriate emergency services.
authors.affiliation: Instituto Carlos Slim de la Salud, Insurgentes Sur 3500, 14060 Ciudad de México, DF, Mexico.
authors.forename: Roberto
authors.initials: R
authors.lastname: Tapia-Conyer
authors.affiliation: Gary and Mary West Health Institute, 10350 N Torrey Pines Road, La Jolla, CA 92037, USA.
authors.forename: Shelley
authors.initials: S
authors.lastname: Lyford
authors.affiliation: Instituto Carlos Slim de la Salud, Insurgentes Sur 3500, 14060 Ciudad de México, DF, Mexico.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Saucedo
authors.affiliation: Gary and Mary West Health Institute, 10350 N Torrey Pines Road, La Jolla, CA 92037, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Casale
authors.affiliation: Instituto Carlos Slim de la Salud, Insurgentes Sur 3500, 14060 Ciudad de México, DF, Mexico.
authors.forename: Hector
authors.initials: H
authors.lastname: Gallardo
authors.affiliation: Gary and Mary West Health Institute, 10350 N Torrey Pines Road, La Jolla, CA 92037, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Becerra
authors.affiliation: Gary and Mary West Health Institute, 10350 N Torrey Pines Road, La Jolla, CA 92037, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mack
authors.affiliation: Instituto Carlos Slim de la Salud, Insurgentes Sur 3500, 14060 Ciudad de México, DF, Mexico.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Mujica
authors.affiliation: Gary and Mary West Health Institute, 10350 N Torrey Pines Road, La Jolla, CA 92037, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Estrada
authors.affiliation: Servicios de Salud de Yucatán, Calle 72, No. 463 Entre 53 y 55, Centro, 97000 Merida, YUC, Mexico.
authors.forename: Antonio
authors.initials: A
authors.lastname: Sanchez
authors.affiliation: Servicios de Salud de Yucatán, Calle 72, No. 463 Entre 53 y 55, Centro, 97000 Merida, YUC, Mexico.
authors.forename: Ramon
authors.initials: R
authors.lastname: Sabido
authors.affiliation: Gary and Mary West Health Institute, 10350 N Torrey Pines Road, La Jolla, CA 92037, USA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Meier
authors.affiliation: Gary and Mary West Health Institute, 10350 N Torrey Pines Road, La Jolla, CA 92037, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Smith