Self-administered tele-ultrasound in fetal telemonitoring: Prospective study

Digital innovations in ultrasound are enabling tele-ultrasound and remote guidance, offering new opportunities to strengthen hospital-at-home care. This study evaluated the feasibility and user experience of self-administered ultrasound by pregnant women with real-time guidance.

This prospective observational cohort study included pregnant women with uncomplicated singleton pregnancies between 24 and 37 weeks of gestation. Participants used the portable tele-ultrasound device Pulsenmore ES (Pulsenmore Ltd., Omer) at home to perform clinician-guided, real-time transabdominal 2D scans twice weekly, completing eight scans over a 28-day period. Real-time guidance was provided by experienced obstetric healthcare professionals. Primary outcome was feasibility, including image acquisition, interpretability, interobserver agreement for saved images, and technical aspects. Secondary outcomes included the System Usability Scale and the self-developed Telemonitoring Survey for user experience. Additionally, a focus group meeting assessed obstetric healthcare professionals' perspectives on the system.

Thirty pregnant women participated, with a mean age of 32.6 years, median body mass index of 23.3 kg/m², and a mean gestational age of 29 weeks (range 24.3-34.5). All participants completed eight ultrasound scans, resulting in 240 tele-ultrasound examinations with a 100% success rate for predefined parameters, including fetal position, fetal heart activity, deepest pocket of amniotic fluid, and placental location. Across the study, remote connection and image acquisition times shortened to a median of 5 and 4 min, respectively. Retrospective analysis was possible for 226 scans, yielding a 99.9% parameter identification rate and perfect interobserver agreement (100%). Technical errors occurred in 16.3% of examinations, mainly due to connection issues. No association was found between scan duration and maternal or pregnancy characteristics such as gestational age, body mass index, and placental location. Participant experience was highly positive, with a mean System Usability Scale score of 80.7 and a satisfaction score of 4.4/5 on the Telemonitoring Survey, reflecting excellent usability. Ultrasound experts found the system user-friendly, with sufficient image quality and functionality.

Self-administered fetal tele-ultrasound is feasible and associated with high user satisfaction and usability. This study supported its potential as a complementary tool in obstetric care, highlighting tele-ultrasound's promise to enhance accessibility, patient engagement, and strengthen hospital-at-home strategies.