Atenção ao pré-natal de baixo risco potencializada por telemedicina: Diretriz clínica prática

Colombo, Talita; Todeschini, Lorenza Bridi; Orlandini, Mariana; Nascimento, Hallana do; Gabriel, Franciele Cordeiro; Alves, Rafael José Vargas; Stein, Airton Tetelbom

Talita Colombo Address for correspondence Talita Colombo, MD, Avenida Ipiranga, 6690, sala 701, 90160-090, Porto Alegre, RS, Brasil (e-mail: talitacolombo@ufcspa.edu.br; talitacolombo.go@gmail.com).

design of the study

data collection

data analysis and/or interpretation

manuscript writing/substantive editing and review

approved the final draft of the manuscript

Postgraduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil

https://orcid.org/0000-0002-2658-752X

Lorenza Bridi Todeschini

design of the study

data collection

data analysis and/or interpretation

manuscript writing/substantive editing and review

approved the final draft of the manuscript

Postgraduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil

https://orcid.org/0000-0002-9593-912X

Mariana Orlandini

design of the study

data collection

data analysis and/or interpretation

manuscript writing/substantive editing and review

approved the final draft of the manuscript

Postgraduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil

https://orcid.org/0000-0001-8123-1983

Hallana do Nascimento

design of the study

data collection

data analysis and/or interpretation

manuscript writing/substantive editing and review

approved the final draft of the manuscript

Postgraduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil

https://orcid.org/0000-0001-7103-330X

Franciele Cordeiro Gabriel

design of the study

data collection

data analysis and/or interpretation

manuscript writing/substantive editing and review

approved the final draft of the manuscript

Postgraduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil

https://orcid.org/0000-0002-4375-3729

Rafael José Vargas Alves

design of the study

data collection

data analysis and/or interpretation

manuscript writing/substantive editing and review

approved the final draft of the manuscript

Postgraduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil

https://orcid.org/0000-0002-6294-917X

Airton Tetelbom Stein

design of the study

data collection

data analysis and/or interpretation

manuscript writing/substantive editing and review

approved the final draft of the manuscript

Postgraduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil

https://orcid.org/0000-0002-8756-8699

Address for correspondence Talita Colombo, MD, Avenida Ipiranga, 6690, sala 701, 90160-090, Porto Alegre, RS, Brasil (e-mail: talitacolombo@ufcspa.edu.br; talitacolombo.go@gmail.com).

Conflict of interests

The authors have no conflict of interests to declare.

	Randomization process	Deviations from the intended interventions	Missing outcomes	Mesurement of the outcomes	Selection of the reported results	Overall bias
Tobah (2019)¹⁰10 Butler Tobah YS, LeBlanc A, Branda ME, Inselman JW, Morris MA, Ridgeway JL, et al. Randomized comparison of a reduced-visit prenatal care model enhanced with remote monitoring. Am J Obstet Gynecol. 2019;221(06):638.e1–638.e8. Doi: 10.1016/j.ajog.2019.06.034 https://doi.org/10.1016/j.ajog.2019.06.0...	Low	Some concerns	Low	Low	Low	Some concerns

	Bias do to counfounding	Bias in selection of participants into the study	Bias in measurement of intervention	Bias due to departure from intended intervention	Bias due to missing data	Bias in measurement of outcomes	Bias in selection of reported results	Overall bias
Meza-Santibañez et al.¹³13 Meza-Santibañez L, Novoa Rommy H, Torres-Osorio J, Jáuregui-Canchari V, Rodríguez-Hilario N, GuevaraRíos E, et al. Implementación de un modelo mixto de atención prenatal, presencial y virtual durante la pandemia COVID-19, en el Instituto Nacional Materno Perinatal en Lima, Perú. Rev Peru Ginecol Obstet. 2021; 67(02):00004. Doi: 10.31403/rpgo.v67i2313 https://doi.org/10.31403/rpgo.v67i2313...	Low	Not informed	Not informed	Not informed	Not informed	Serious	Not informed	Not informed
Palmer et al.¹⁴14 Palmer KR, Tanner M, Davies-Tuck M, Rindt A, Papacostas K, Giles ML, et al. Widespread implementation of a low-cost telehealth service in the delivery of antenatal care during the COVID-19 pandemic: an interrupted time-series analysis. Lancet. 2021;398 (10294):41–52. Doi: 10.1016/S0140-6736(21)00668-1 https://doi.org/10.1016/S0140-6736(21)00...	Low	Low	Low	Low	Some concerns	Low	Low	Low

Periodic/Year	First author	Country	Participants	Study period	Design and details	Population characteristics	Outcomes of interest
American Journal of Obstetrics and Gynecology/2019	Tobah¹⁰10 Butler Tobah YS, LeBlanc A, Branda ME, Inselman JW, Morris MA, Ridgeway JL, et al. Randomized comparison of a reduced-visit prenatal care model enhanced with remote monitoring. Am J Obstet Gynecol. 2019;221(06):638.e1–638.e8. Doi: 10.1016/j.ajog.2019.06.034 https://doi.org/10.1016/j.ajog.2019.06.0...	USA	300 (T n = 150 H n = 150)	Sep 2011–Dec 2011	Randomized clinical Trial. T = 12 onsite appointments. H = 8 onsite appointments and 6 virtual visits; supplemented with wereables.	Low risk pregnant patients Aged 18–36 years. Obstetric tertiary center	Evaluate the acceptability and effectiveness of the hybrid prenatal program (OB Nest). Maternal and fetal outcomes of interest also were evaluated.
Am J Matern Child Nurs/2016	Pflugeisen¹²12 Pflugeisen BM, McCarren C, Poore S, Carlile M, Schroeder R. Virtual Visits: Managing prenatal care with modern technology. MCN Am J Matern Child Nurs. 2016;41(01):24–30. Doi: 10.1097/NMC.0000000000000199 https://doi.org/10.1097/NMC.000000000000...	USA	1058 (Tn = 941 Hn= 117)	May 2011–Dec 2013	Clinical trial, without randomization Patients could choose between T and H prenatal care. T = 14 onsite appointments H = 9 onsite appointments and 5 virtual visits.	Low risk pregnant patients. Mean age T = 29.1 Mean age H = 30.3. Obstetric tertiary center	Evaluate demographic variables, pregnancy and birth outcomes, and use of the health system.
Lancet/2021	Palmer¹⁴14 Palmer KR, Tanner M, Davies-Tuck M, Rindt A, Papacostas K, Giles ML, et al. Widespread implementation of a low-cost telehealth service in the delivery of antenatal care during the COVID-19 pandemic: an interrupted time-series analysis. Lancet. 2021;398 (10294):41–52. Doi: 10.1016/S0140-6736(21)00668-1 https://doi.org/10.1016/S0140-6736(21)00...	Australia	23.008 (T n = 20.031 H n = 2977)	Jan 2018–Mar 2020	Non- randomized study. An uninterrupted time series.	High and low risk pregnant Age T = 31–29 (5.19) Mean age H = 31–61 (5.04). Publicly maternity, two secondary and one tertiary referral hospitals	Comparison between traditional prenatal period and hybrid prenatal care in several factors (preeclampsia, stillbirth, CIUR…).
Rev Peru Ginecol Obstet/2021	Meza-Santibañez¹³13 Meza-Santibañez L, Novoa Rommy H, Torres-Osorio J, Jáuregui-Canchari V, Rodríguez-Hilario N, GuevaraRíos E, et al. Implementación de un modelo mixto de atención prenatal, presencial y virtual durante la pandemia COVID-19, en el Instituto Nacional Materno Perinatal en Lima, Perú. Rev Peru Ginecol Obstet. 2021; 67(02):00004. Doi: 10.31403/rpgo.v67i2313 https://doi.org/10.31403/rpgo.v67i2313...	Peru	NA	May 2020–Dec 2020	Descriptive study, theorical model.	High and low risk pregnant No patients enrolled.	Describe the new hybrid prenatal program with telemedicine of the Instituto Nacional Materno-perinatal
Matern Child Health/2017	Pflugeisen¹¹11 Pflugeisen BM, Mou J. Patient satisfaction with virtual obstetric care. Matern Child Health J. 2017;21(07):1544–1551. Doi: 10.1007/s10995-017-2284-1 https://doi.org/10.1007/s10995-017-2284-...	USA	1,173 (T n = 795 H n = 378)	Mar 2013–Jan 2016	Cross-sectional study	Low risk pregnant Age T = 31.2 ± 4 Mean age H = 31.5 ± 5 Obstetric tertiary center	Check satisfaction in patients who received a hybrid model of prenatal with teleconsultations and those who received traditional prenatal care

[1] Address for correspondence Talita Colombo, MD, Avenida Ipiranga, 6690, sala 701, 90160-090, Porto Alegre, RS, Brasil (e-mail: talitacolombo@ufcspa.edu.br; talitacolombo.go@gmail.com).

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Atenção ao pré-natal de baixo risco potencializada por telemedicina: Diretriz clínica prática

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