High-risk pregnancies and vulnerable newborns: telemedicine brings specialists to small hospitals

The process should begin at antenatal clinics, which are responsible for identifying at an early stage any conditions requiring a higher level of care. Women with uncomplicated pregnancies will be able to continue receiving care in their local area, whilst those with complications will be able to undergo joint specialist assessments and, if necessary, be referred to a better-equipped centre.

Telemedicine may also be used for certain check-ups during pregnancy, via teleconsultations and the monitoring of parameters such as blood pressure and blood glucose levels, where clinically appropriate. However, it will not replace ultrasound scans, diagnostic tests and consultations that necessarily require the patient’s physical presence.

When a baby is born in a critical condition at a local hospital, a link with a specialist centre will enable doctors to receive immediate guidance on stabilising the baby, share test results and assess whether transfer to a neonatal intensive care unit is necessary.

The document integrates this process with the assisted maternal transport (STAM) and neonatal emergency transport (STEN) systems. The principle is to transfer the woman before delivery, where possible, if the baby is expected to require intensive care; where, on the other hand, the emergency arises after birth, the priority becomes stabilising the newborn and organising the most appropriate transport. In some cases, specialist consultation may enable care to continue at the hospital of origin, thereby avoiding unnecessary transfers.

For premature, vulnerable or high-needs newborns, Agenas envisages the use of teleconsultations, telemonitoring and tele-support, involving paediatricians of the parents’ choice, midwives, antenatal clinics and specialists. This model aims to reduce avoidable hospital admissions, support parents and identify any problems at an early stage.

The aim is to support mothers and babies on a journey that does not end with discharge from hospital. Of particular importance is the link with local services and the local operations centres, which are tasked with facilitating the connection between the hospital and community care.

These guidelines do not amount to the immediate and uniform roll-out of new services. For the model to work, there must be interoperable platforms, trained staff, effective links between hospitals and antenatal clinics, the availability of specialists, and efficient transport systems. Technology alone cannot compensate for a lack of expertise or adequate facilities.

Agenas also provides indicators to measure the quality of care pathways and patient outcomes. It is precisely the ability to monitor results, as well as to adopt digital tools, that will determine the practical benefits of the reorganisation.

For families, the question is simple: will living far from a major hospital continue to mean greater difficulties in accessing the most specialised care? The new guidelines offer a possible organisational solution. Ensuring this is implemented consistently across the country will be the litmus test for the regions and health authorities.