Telehealth usefulness during postpartum hemorrhage management: a systematic review

OBJECTIVE: This literature systematic review aims to evaluate tele-medicine's effect in managing postpartum hemorrhage. DATA SOURCES: MEDLINE (Ovid), Embase (Ovid), and the Cochrane Library were consulted from inception to March 27, 2024. STUDY SELECTION: 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 COLLECTION AND ANALYSIS: 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. RESULTS: 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. LIMITATIONS: The included studies were heterogeneous in design, interventions, and outcomes, and most had observational designs, limiting the strength of the evidence. CONCLUSION: 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.