Liat Mor, MD¹, Hagit Eisenberg, MD¹, Liliya Tamayev, MD¹, Daniel Tairy, MD¹, Ben Oren, MD¹, Yael Ganor Paz, MD¹, Michal Levy, MD¹, Eran Weiner, MD¹, Giulia Barda, MD¹

¹Department of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Abstract
Purpose To evaluate the effect of incorporating twice-weekly telemedicine home ultrasound sessions on maternal anxiety
and antenatal attachment in pregnant patients with a history of late pregnancy loss.

Methods In this quasi-randomized trial, pregnant patients with a previous pregnancy loss beyond 20 weeks of gestation were
randomized per day of enrollment to standard high-risk care (control) or additional twice-weekly home ultrasound sessions
(intervention). Maternal anxiety and antenatal attachment were assessed at baseline, mid-pregnancy, and final prenatal visit
using the State–Trait Anxiety Inventory Scale (STAI-S) and the Maternal Antenatal Attachment Scale (MAAS-2). The
primary outcome was the STAI-S score at the final visit. A total of 50 participants (25 per group) were required to detect a
20% difference in the primary outcome.

Results Demographics were comparable between groups. The intervention group demonstrated significantly lower STAI-S
scores at mid-pregnancy (46.7 ± 9.3 vs. 52.0 ± 9.0; p = 0.023) and at the final visit (43.6 ± 11.8 vs. 51.5 ± 11.5; p = 0.004),
and higher MAAS-2 scores at the final visit (79.5 ± 6.2 vs. 75.0 ± 6.9; p = 0.022). Attachment scores increased significantly
during follow-up (4.8 ± 7.3 vs. − 0.36 ± 8.0; p = 0.023). Emergency department visits were fewer in the intervention group
(3.1 ± 1.5 vs. 4.9 ± 3.3; p = 0.024). Regression analyses confirmed independent associations between home ultrasound use,
reduced anxiety, and improved attachment.
Conclusion Telemedicine home ultrasound significantly reduced maternal anxiety and improved antenatal attachment in
patients with prior late pregnancy loss. This reassurance strategy may also decrease unscheduled emergency visits, supporting
its integration into standard prenatal management in this vulnerable population.

Keywords Stillbirth · Pregnancy loss · Telemedicine · Anxiety · Attachment

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Abstract

In recent years, the proportion of pregnant women now classifying as high-risk has increased. This is primarily due to guideline changes, implementation of national initiatives and an ageing maternal population. The requirement for serial antenatal maternal-fetal monitoring has therefore increased, placing a significant strain on outpatient obstetric services to cope with the increased demand. Advancements in digital medical innovation, combined with improvements in technological infrastructure has led to increasing development of methods for telemedicine and remote monitoring in both research and clinical settings of antenatal care. The recent pandemic has had also a substantial influence on technology development, as obstetric outpatient services were required to consider alternative solutions to the provision of antenatal care. This spotlight article presents the latest research in telemedicine and remote monitoring for obstetric antenatal care.

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Abstract

Background: Ovarian follicles and endometrial thickness are monitored repeatedly for assisted reproduction, burdening patients and clinics. Self-scans with a home ultrasound device can relieve this.

Objective: We aimed to evaluate the reliability of self-scans using the smartphone-based Pulsenmore follicle count vaginal self-scan device (FC) versus in-clinic (IC) sonographies, in ovarian stimulation for in-vitro fertilization or fertility preservation.

Methods: This study is a single-center, interventional, controlled, prospective study including 44 patients without pelvic pathologies undergoing stimulation for in-vitro fertilization (2022‐2024). Following training, patients used a vaginal home ultrasound device to scan their uterus and ovaries with remote guidance by a sonographer in each cycle check-point. Clinical decisions were based on standard IC sonographies. FC and IC results were compared for image quality, endometrial thickness, and follicle count or size. Aspirated oocyte numbers were compared to the follicles recorded at the last visit by home and IC scans. Absolute differences in follicular count and endometrial thickness between IC and FC scans were compared using means, SDs, and 95% CIs. The Spearman correlation (r) analyzed the relations between IC and FC outcomes. All tests applied were 2-tailed, with a P value of ≤5% considered statistically significant. Patient and sonographer satisfaction were assessed via surveys.

Results: Of 44 patients, 34 completed this study. The mean age was 34.7 (SD 4.0) years, and BMI was 25.8 (SD 5.0) kg/m². A total of 65% (22/34) pursued fertility preservation and 35% (12/34) aimed to conceive. The image quality scores of all home scans were at a minimum suitable level, with most of better quality. FC measurements closely matched IC findings for key clinical parameters: antral follicle count (mean FC 11.94, SD 6.62 vs mean IC 15.23, SD 10.2, ρ=0.86, P<.001); number of stimulated follicles ≥10 mm (FC 12.19, SD 6.27 vs IC 13.5, SD 8.87, ρ=0.84, P<.001); identification of the leading follicle >14 mm (achieved in 87% of FC scans); and follicular number or size pretriggering. The aspirated oocyte or last-visit stimulated follicles (>10 mm; FC 1.12, SD 0.6 vs IC 1.06, SD 0.56, ρ=0.82, P<.001), mature oocytes or follicles >13 mm ratios (FC 1.28, SD 1.11 vs IC 1.04, SD 0.77, ρ=0.88, P<.001), and endometrial thickness pretriggering (FC 9.87, SD 2.2 mm vs IC 9.63, SD 2.7 mm, ρ=0.54, P=.002) were well-correlated between the home and standard scans, with 87.1% concordance in identifying endometrial adequacy (≥7 mm). In the patient survey, 82% (28/34) expressed interest in future use of the FC device. In the sonographer survey, 91% (31/34) demonstrated patient improvement.

Conclusions: The home ultrasound device was feasible, comparable, and well-correlated with standard IC scans, laying the basis for remote home-based monitoring of follicular development during ovarian stimulation. We believe this also applies to monitoring milder stimulations and even natural cycles.

Full article: https://www.jmir.org/2025/1/e72607

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https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-025-07664-3#citeas

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The post Hybrid remote and in-clinic maternal-fetal surveillance for women with gestational diabetes: A prospective pilot study appeared first on PULSENMORE | Home Ultrasound.

By: Ben Shitrit I., Kedmi A., El Haj K., Kosto A., Karni O., Poleg T., Bineth N., Gat T., Shnaider A., Fuchs L.,

Presented at: AIUM 2024

Objectives

Patient-performed pulmonary ultrasound scans in a telemedicine model may be used to track the progression of pulmonary congestion, potentially reducing hospital admissions. A pilot study was conducted

to assess the feasibility of hemodialysis (HD) patients using a self-operated mobile phone-based ultrasound (MPBU) device to detect pulmonary B-lines at home as an indicator of volume overload.

Methods

A prospective pilot study was conducted at a single medical center involving patients with chronic end-stage renal disease undergoing HD. Patients were recruited and trained to self-scan their lungs using the Pulsenmore-MPBU device. Self-operated scans were compared with scans performed by a physician using both the inexpensive MPBU device and a gold-standard conventional point of care ultrasound (POCUS) device (Venue Go TM, GE Healthcare).

Detection of pulmonary B-lines and scan quality scores were assessed by an independent blinded sonographer, following clip shuffling to prevent order bias. We used the weighted Cohen’s kappa (Kw) index to examine agreement degrees regarding B-lines classification, the Mann-Whitney U test, and Spearman’s correlation coefficient to evaluate the quality rankings.

to assess the feasibility of hemodialysis (HD) patients using a self-operated mobile phone-based ultrasound (MPBU) device to detect pulmonary B-lines at home as an indicator of volume overload.

EVALUATION

Detection of lung B-lines and evaluating scan quality

Results

11 HD patients were recruited; 2 were excluded due to significant visual impairments ornoncooperation. During the study, 657 clips were analyzed; participants recorded 167 using the Pulsenmore MPBU device, researchers recorded 245 with the Pulsenmore-MPBU, and researchers used the Venue Go device for 245. Mean and median follow-up was 36.33 (SD 14.85) and 32 days (IQR 23), respectively.

 

Before hemodialysis (HD), patients’ self-operated scans and physician-operated scans, using the Pulsenmore-MPBU, showed substantial agreement in B-line count classification (N=146, Kw=0.64[95%CI:0.46–0.82]). Regarding the quality score rankings, there was a moderate correlation, as indicatedby a Spearman’s rs of 0.582 (N=159, p< 0.001), and a difference between operators’ scan quality when both using the Pulsenmore-MPBU device as shown by the Mann-Whitney U test result (U=12322,p=0.003).

 

Before HD, when a physician operated both the Pulsenmore-MPBU device and conventional ultrasound device, there was a moderate agreement for B-line count classification (N=149, Kw=0.58[95%CI:0.41–0.75]).

 

Additionally, for the quality score rankings, a moderate correlation was demonstrated between devices with a Spearman’s rs of 0.645 (N=155, p< 0.001), but no difference in video quality as presented by the Mann-Whitney U test result (U=13253, p=0.53).

This agreement was more substantial after HD, indicating consistent device performance with an almost perfect agreement for B-line count classification (N=57, Kw=0.81[95%CI:0.65–0.97]).

In the quality score rankings performed by a physician, there was again a moderate correlation between devices, shown by a Spearman’s rs of 0.65 (N=62, p<0.001), and similarity in video quality as presented by the Mann-Whitney U test result (U=2952, p=0.48). No adverse events were recorded during the study.

Conclusions

Patients demonstrated the ability to self-scan their lungs at home, producing scans of satisfactory accuracy and quality for detecting pulmonary congestion. This study establishes the feasibility of using the Pulsenmore-MPBU device for self-performed ultrasound scans to monitor volume overload in HD patients.

 

The findings suggest a cost-effective telemedicine approach that could facilitate early detection of patient deterioration, potentially reducing hospital admissions and promoting patient empowerment inself-monitoring. Such outcomes could benefit not only HD patients but also other patient groups, such as those with chronic heart failure.

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Affiliations

• Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.
• Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
• Translational Innovation and eHealth Wing, Clalit Health Services, Tel Aviv, Israel.

Conclusion: FHR and MVP measurements obtained from scans captured by the self-operated Pulsenmore ES ultrasound platform are highly accurate and reliable for clinical use relative to standard in-clinic measurements.

Review

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The post The effect of home ultrasound on maternal anxiety in patients with previous recurrent pregnancy loss: A randomized control trial appeared first on PULSENMORE | Home Ultrasound.

Conclusion: Integrating routine home-ultrasound telemedicine visits into prenatal care can significantly reduce maternal anxiety during pregnancy and contribute to greater maternal attachment in individuals with a history of recurrent pregnancy loss. These results emphasize the potential benefits of home ultrasound as a tool to alleviate anxiety, provide a sense of control, and foster a deeper maternal connection among pregnant individuals who have experienced previous pregnancy loss.

The post The Potential of Tele‐Ultrasound, Handheld and Self‐Operated Ultrasound in Pregnancy Care: A Systematic Review appeared first on PULSENMORE | Home Ultrasound.

Conclusion: Remote fetal well-being assessment is feasible and time-saving and results in high patient satisfaction. This novel paradigm of comprehensive remote maternal and fetal assessment is associated with important clinical, socioeconomic, and logistics advantages.

The post Integrating technologies to provide comprehensive remote fetal surveillance: A prospective pilot study appeared first on PULSENMORE | Home Ultrasound.