Telehealth usefulness during postpartum hemorrhage management: a systematic review

This literature systematic review aims to evaluate tele-medicine's effect in managing postpartum hemorrhage.

MEDLINE (Ovid), Embase (Ovid), and the Cochrane Library were consulted from inception to March 27, 2024.

Studies evaluating tele-medicine interventions (including tele-education, tele-consultation, virtual interventions for improving hospital processes) in the management of postpartum hemorrhage were included, without restrictions on study design.

Data extraction and quality assessment were performed. Due to substantial heterogeneity across studies, a meta-analysis was not conducted, and results were synthesized narratively. Risk of bias was assessed using the Newcastle-Ottawa Scale for cohort studies.

Nineteen studies were included. Most were conducted in low and middle-income countries (n=17/19) and used observational or quasi-experimental design (n=15/19). Four cluster randomized controlled trials evaluated the effectiveness of virtual training strategies, although only in one of them clinical variables were incorporated. Most studies reported improvements in process-related or clinical outcomes following telemedicine interventions. Reported barriers included limited funding, challenges in implementing recommendations at local hospitals, and lack of incentives for sustained use.

The included studies were heterogeneous in design, interventions, and outcomes, and most had observational designs, limiting the strength of the evidence.

Developing and maintaining resilient health systems to address postpartum hemorrhage in low-resource settings requires innovative approaches that adapt technology to the context to enhance health outcomes. One such innovation could be tele-medicine, but further research is needed on barriers to implementation and translating the potential benefits of education and timely interaction between patients and expert groups into improved clinical outcomes.PROSPERO: #CRD42023448275.