Am J Perinatol 2020; 37(08): 800-808
DOI: 10.1055/s-0040-1712121
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Telehealth for High-Risk Pregnancies in the Setting of the COVID-19 Pandemic

Aleha Aziz
1  Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
,
Noelia Zork
1  Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
,
Janice J. Aubey
1  Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
,
Caitlin D. Baptiste
1  Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
,
Mary E. D'Alton
1  Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
,
Ukachi N. Emeruwa
1  Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
,
Karin M. Fuchs
1  Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
,
Dena Goffman
1  Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
,
Cynthia Gyamfi-Bannerman
1  Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
,
Jennifer H. Haythe
2  Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
,
Anita P. LaSala
1  Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
,
Nigel Madden
1  Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
,
Eliza C. Miller
3  Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
,
Russell S. Miller
1  Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
,
Catherine Monk
1  Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
4  Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
5  New York State Psychiatric Institute, New York, New York
,
Leslie Moroz
1  Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
,
Samsiya Ona
1  Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
,
Laurence E. Ring
6  Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, New York
,
Jean-Ju Sheen
1  Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
,
Erica S. Spiegel
1  Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
,
Lynn L. Simpson
1  Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
,
Hope S. Yates
1  Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
,
Alexander M. Friedman
1  Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
› Author Affiliations
Funding None.
Further Information

Publication History

23 April 2020

24 April 2020

Publication Date:
12 May 2020 (online)

Abstract

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.

Key Points

  • Telehealth for prenatal care is feasible.

  • Telehealth may reduce coronavirus exposure during prenatal care.

  • Telehealth should be tailored for high risk prenatal patients.