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ThinkMind // International Journal On Advances in Life Sciences, volume 11, numbers 3 and 4, 2019 // View article lifsci_v11_n34_2019_6


Telehealth-based Intrapartum Monitoring: Impact of Clinical and Technical Factors on Remote Decision Making

Authors:
Sujitkumar Hiwale
Navaneetha Krishnan
Jeevan Ram Addepalli
Shrutin Ulman

Keywords: feasibility study; inter-observer variability; intrapartum; mHealth; obstetrics; partograph; telemedicine

Abstract:
Digital Labour and Delivery Solution (DLDS) is a mHealth-based solution for structured and instant communication during intrapartum care. The primary objectives of this study were – (1) to evaluate feasibility of the DLDS for information exchange among healthcare professionals for remote intrapartum monitoring and decision making; and (2) to study impact of various clinical and technical factors on decision agreements between the doctors. The inclusion criteria for the study were, a live-singleton pregnancy with cervical dilatation > 4 cm but < 8 cm at the time of admission, and presenting without any complication necessitating any immediate intervention. The feasibility of the DLDS was evaluated by comparing the decisions taken by a remote doctor using the DLDS to that of decisions taken by a doctor in a labour room. Impact of clinical parameters (mother’s age, parity, anemia and presence of intrapartum complications) on decision agreement between the doctors was studied by comparing agreements in different subcategories of these parameters. Similarly, the total number of observation records for a subject were also studied to find their impact on decision making. The overall agreement between the two doctors for 110 cases (220 independent decision points) was 0.764 using unweighted Cohen’s kappa and 0.723 using weighted Cohen’s kappa statistic. The doctors had comparable agreements in all the sub-categories of the clinical parameters, indicating minimal impact of clinical parameters on decision agreement between the doctors. A significant improvement was observed in the agreement as the total number of assessments available during the course of labour increased. The substantial agreement between the two doctors for intrapartum decision making demonstrates the feasibility of the DLDS for remote intrapartum monitoring and decision making. This also indicates that DLDS was able to convey the appropriate information to the remote doctor in the different sub-categories of the clinical parameters. The study recommends further investigation of DLDS for a general purpose remote intrapartum monitoring.

Pages: 151 to 159

Copyright: Copyright (c) to authors, 2019. Used with permission.

Publication date: December 30, 2019

Published in: journal

ISSN: 1942-2660

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