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All Posts in Category: Maternal Fetal Medicine

The Engineer Inside the Physician

Dr. C. Anne Patterson’s Journey into Telemedicine

Telemedicine — the delivery of healthcare via telecommunication technologies — has been around for decades. But it took an engineer to get it just right. 

“We were doing telemedicine at NASA in the early 70’s, but it was completely ‘unsophisticated’ by current standards,” says Georgia Tach aerospace engineering alumna C. Anne Patterson, a board-certified OBGYN and CEO of the Sandy Springs-based Women’s Telehealth.

“We used a satellite to provide information about birth control that people in India could watch in between regular television programing,” remembers Patterson. “I was a propulsion engineer working on that satellite. Later, the satellite was re-purposed to send medical information to physicians in very remote areas of the Rocky Mountains. And that was the extent of our ‘telemedicine’ in the 70s.”

Four decades later, the telemedicine that Patterson now practices is much more than a medically-themed infomercial beamed down from a satellite. It is a systematic use of several technologies (including satellites), all with the goal of delivering personalized medical care directly to patients in remote areas. Telemedicine is also removing one of the largest barriers to health care delivery in the rural South: a chronic shortage of specialized medical practitioners.  

“We’ve been able to set up clinics in seven southern states,” says Patterson. “We’ve reached more than 30,000 mostly low-income women — women who would not have access to maternal-fetal health. This is what modern telemedicine is capable of doing.”

Finding her Specialty

Patterson chose her medical specialty — maternal-fetal medicine — in part because it plays such a critical role in Georgia, which has some of the highest rates in the United States for maternal mortality and pre-term delivery, particularly among women of color. 

 “We conducted a study in Albany Georgia — an area that had preterm birth rates of 18 percent for African-American women, and 16 percent for Hispanic women,” says Patterson. “Those rates were the highest in the state. While it was a tough region to choose, everyone was receptive to trying something new to make a difference.” After bringing telemedicine into the area for 18 months, pre-term birth rates dropped to 8 percent and 6 percent respectively, which is lower than the national average. To date, the rates remain at this level or lower.

Telemedicine is uniquely suited to address the problems faced by the rural poor, Patterson points out. It does not involve high transportation costs, travel time, childcare, or Medicaid. With all of these barriers eliminated, patients are more likely to initiate and maintain contact with the medical system earlier in their pregnancies. Women’s Telehealth helps these high-risk patients to manage chronic health problems — like diabetes and hypertension — that could threaten their pregnancies.  

In a typical consultation with Patterson, the conversation rarely ends when doctor and patient have checked off all the obvious medical issues, however. Before the video shuts down, Patterson leans into a more motherly consult with her patients, who have likewise relaxed their once-tense postures. At these moments, it’s a little easier to understand why Patterson is still seeing patients long past the point when most physicians would have retired.

Complete article go to: https://coe.gatech.edu/news/2019/11/engineer-inside-physician

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Yes! Get a Flu Shot During Pregnancy

August is National Immunization Awareness Month. It’s a great time for Women’s Telehealth to stress the importance of influenza (flu) vaccination for all moms-to-be, during any trimester. Both the CDC and the American College of Obstetricians and Gynecologists have recommended for years that pregnant women and women who are breastfeeding get the flu vaccine.

Vaccines are made with the highest of safety standards. The influenza vaccine has been proven safe and effective and has not been known to cause pregnancy problems or birth defects. The U.S. FDA approves all vaccines and the CDC monitors all approved vaccines regularly.

How does being pregnant increase the risk of complications from the flu? 

Pregnant women are a high risk group for flu due to normal changes in the immune system during pregnancy. Flu is more likely to cause severe illness in pregnant women than in women of reproductive age who are not pregnant. Pregnant women who contract the flu are also at a higher risk for complications of pregnancy such as preterm labor. A 2018 study showed that getting a flu vaccine while pregnant reduced a pregnant women’s risk of getting hospitalized with the flu by 40%.

When pregnant, the flu vaccine does “double duty” by protecting the baby as well. When a pregnant woman gets the flu vaccine, she makes protective antibodies that are transferred to baby. Infants younger than 6 months are at high risk for serious flu-related complications, but once born, are not approved for influenza vaccination until 6 months or older.

What type of flu vaccine should a pregnant woman get?

Flu vaccines are administered to adults in two ways: injection (shot) into the arm muscle and nasal spray that is inhaled. The shot contains the flu virus in an inactivated form so there’s no risk of it causing the disease. The shot therefore is the recommended form of influenza vaccine during pregnancy. The nasal spray is “live” flu virus and is NOT recommended for pregnant women.

Since the types of virus that can cause flu change, annual flu vaccination is recommended. The side effects of most vaccines are mild and last only a day or two.  However, if you have any concerns about side effects after you receive the flu vaccine, consult your obstetrician.

What should you do if you get the flu while you are pregnant?

If you are pregnant and think you have the flu, contact your obstetrician right away. Some symptoms of the flu include: fever, chills, body ache, headache, fatigue, cough, sore throat or runny nose. Antiviral medication is available by prescription and has value if taken within 48 hours of the onset of flu. This medicine will not prevent flu. but often shortens the length and severity of flu. You should also contact your obstetrician if you think you may have come in contact with someone who has the flu.

For more information on Pregnancy and Flu visit: https://www.acog.org/Patients/FAQs/The-Flu-Vaccine-and-Pregnancy?IsMobileSet=false or https://www.cdc.gov/flu/highrisk/qa_vacpregnant.htm

Tanya Mack, President

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Uncontrolled Diabetes and Pregnancy: Doubly Important

This Pregnancy’s Challenge:

An 18 year old patient presented in a rural area to the local OB physician when she was 16 weeks pregnant. Her OB history showed she had been diagnosed with Type I Diabetes at age 5. She had been seeing a local endocrinologist but was told he would not follow her and manage her insulin during pregnancy.

The close diabetic monitoring required throughout the pregnancy would need to be provided by a Maternal-Fetal Specialist. Because the closest one was approximately 1 ½ hours from the patient’s home, she was referred to Women’s Telehealth by her local OB physician for co-management. Women’s Telehealth provided MFM care through telemedicine visits.
Of additional concern was that the patient was noted to be non-compliant in her insulin regime and diabetic care.

The Team’s Actions:

  • Initially, the patient was taking both long-acting insulin daily and at bedtime, and rapid-acting insulin with meals. She had an implanted blood glucose monitor and was to follow an ADA diet.
  • During her initial MFM consult, Women’s Telehealth counseled the patient to monitor and bring her blood sugar logs and insulin regime to every visit. 
  • For four weekly visits, the patient did not follow instructions.  Women’s Telehealth continued to counsel her as to the potentially poor outcomes for the baby if her blood sugar was not controlled, as well as the importance of complying with the monitoring, diet and insulin regime. During this time, her baby slipped from the 55th percentile to the 29th percentile.  Not a positive trend. 
  • Women’s Telehealth provided on-going insulin management, ultrasound fetal monitoring and counseling regarding non-compliance. With positive reinforcement, SOMETHING CHANGED!
  • Her 18-20 week anatomy scan was normal.
  • From 23 through 33 weeks, the patient started bringing in her blood sugar logs and her insulin levels became controlled.  In fact, she reported they were, “the best they’ve ever been.” The baby grew from the 29th percentile to the 52nd percentile. Dopplers and antenatal testing showed GREAT improvement. 

The Results:

  • The story has not ended as the baby has not delivered. But, the baby is healthy and within a few weeks of a safe delivery.  The patient was moved to an “all as needed” status with her insulin regime and blood sugars under control.
  • Through telemedicine, the patient was able to stay local and receive the needed medical care, as she could not have traveled outside of her area.
  • The tele-MFM option greatly improved patient compliance and results.  
  • The patient realized travel savings of 1,980 miles and over 35 hours.                                                                                                                                                                      

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The prevalence of diabetes in pregnancy in the U.S. is increasing. Pre-existing, Type I diabetes confers an increased and more significant risk to both mom and baby than gestational diabetes. Tight blood sugar control is critically important at all stages of pregnancy. Uncontrolled diabetes in pregnancy can lead to such complications as fetal anomalies, pre-eclampsia, fetal demise, macrosomia, neonatal hypoglycemia and spontaneous abortion.

 To learn more, visit: https://www.cdc.gov/pregnancy/diabetes-types.html

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Our goal in sharing patient case stories is to show the role and possibilities Women’s Telehealth plays in accessing high risk situations and  to help turn patient and OB provider concern into the best possible care plans and outcomes for mom’s and their babies. For more information, call our office at:  404.478.3017              

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Baby’s Gastroschisis: Early Diagnosis and Preparedness Made the Difference!

How to successfully manage the complexities of gastroschisis in pregnancy is the focus of this Women’s Telehealth patient story. [Pictured above: Gastroschisis Baby – Post Op]

This Pregnancy’s Challenge:

At the anatomy ultrasound scan at 17 weeks, the OB physician found that his 24 year old Caucasian patient had a suspected gastroschisis.

Gastroschisis is a birth defect in which the fetus’ intestines and/or stomach protrude outside the abdominal wall. A baby with this condition requires immediate surgery after birth to place the organs in the proper place in the abdominal cavity and close the hole in the abdominal wall. Hospitalization is also needed for an extended period of time to ensure that the baby’s feeding and digestive tract are functioning well. Most babies with appropriate care and surgery at birth will grow up to have normal lives. Successful outcomes often depend on early identification of this birth defect and preparing for surgery upon birth.

In addition to the suspected gastroschisis, other complicating factors included mom’s obesity, pregnancy-induced hypertension, low amniotic fluid, abnormal cervix and active kidney disease. The mom-to-be also needed an extra dose of oversight and compassion due to the loss of a baby during a previous pregnancy, caused by open neural tube defect.

The mom-to-be was referred by the OB physician to Women’s Telehealth maternal-fetal medicine (MFM) physicians for diagnosis and collaborative pregnancy management. Women’s Telehealth was asked to manage BOTH infant and maternal pregnancy complications.

The Team’s Actions:

  • The patient was seen multiple times by Women’s Telehealth to assess her baby’s and her own well-being. The severity of the baby’s birth defect was moderate.
  • Advanced, serial “live” ultrasound imaging for fetal growth and well-being was performed including: targeted ultrasound scan, fetal echo, BPP, Dopplers, cervical length and AFI measurements.
  • Mom was admitted to the hospital for low amniotic fluid once during her pregnancy.
  • Mom was counseled for what to do in the event of pre-term labor.
  • Women’s Telehealth arranged for a pre-delivery consult with a pediatric surgeon at CHOA in Atlanta, as the baby would be transferred to the pediatric hospital as soon as it was born.                          
  • Women’s Telehealth arranged for a local Atlanta OB GYN group to deliver the baby via C-Section due to the birth defect.           

The Results:       

  • Weekly monitoring by the Women’s Telehealth MFM doctor showed a worsening of the mom’s kidney disease.
  • The decision was made to deliver the baby via C-section at 35 weeks at a hospital close to the children’s hospital where the baby would have its surgery and remain for some time.
  • A baby girl weighing 6 lbs. 3 oz., with Apgar scores of 8/8, was delivered without incident.
  • The baby was promptly transferred to the children’s hospital where successful closure surgery was performed.

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The CDC estimates that Gastroschisis affects 1 in every 1,900 babies born in the U.S. each year. The cause of this birth defect is currently unknown but researchers have speculated that potential causes may be adaptations in genes and/or the lifestyle or environment of the mother.  Young, Caucasian women are the most common population to be at risk. For more information about this condition visit:  https://www.cdc.gov/ncbddd/birthdefects/gastroschisis.html

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WT partners with OB/GYN physicians and healthcare facilities to provide the highest level of Maternal-Fetal Medicine (MFM) available through telemedicine.  WT provides services in local hospitals, doctor’s offices and government clinics.

Our goal in sharing patient case stories is to show the role and possibilities Women’s Telehealth plays in accessing high risk situations and to help turn patient and OB provider concern into the best possible care plans and outcomes for moms and their babies. For more information, call our office at:  404.478.3017

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Alliance Establishes New Tele-MFM Service Line and Geo-expansion

Women’s Telehealth and Eagle Telemedicine are working together to bring scarce, high risk OB services to more communities across the country!

Eagle Telemedicine is a premier telemedicine organization with a national network that brings a wide variety of healthcare providers to acute and critical access hospitals and health organizations. They provide night coverage and specialty care as well as fill staffing gaps, all exclusively by telemedicine. Eagle Telemedicine provides over 20,000 telemedicine patient encounters annually. Women’s Telehealth has completed over 31,000 maternal fetal medicine patient encounters/studies.

“This alliance will expand the capabilities of both companies,” said Women’s Telehealth President, Tanya Mack. “Eagle Telemedicine now adds maternal-fetal medicine to their service line and Women’s Telehealth gains expanded geographic coverage.” Builders and shapers in their respective areas of the telemedicine industry, the companies share mutual goals of bringing much needed specialty care to where it is needed and serving the underserved in a sustainable, cost effective manner. The companies’ combined strengths will allow high risk moms to keep their care local and allow hospitals and healthcare organizations to retain their patients and provide scarce specialty care.

For more information visit:

http://: https://www.eagletelemedicine.com/telemedicine-services/telespecialty-services/telematernal-fetal-services/
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How Group B Strep Seriously Affects Pregnancy and Newborns

As part of July Group B Strep Awareness Month, Women’s Telehealth encourages all pregnant women to make sure they complete their Group B Strep testing as part of routine prenatal care.

Group B Streptococcus (GBS) lives in the body naturally and it is a bacteria normally found in 25% of health adult women’s rectum or vagina. Women who test positive for GBS are considered “colonized” or a “carrier.”

GBS is not normally harmful to the mother, but can be harmful to the newborn. A pregnant woman can pass on this infection to the baby during delivery. Not every mom will have symptoms of a GBS infection and not every baby born to a mom with a GBS infection will become ill. While GBS disease can be deadly, there are steps pregnant women can take to help protect their babies.

GBS Testing

The CDC recommends all pregnant women get tested for GBS between 35-37 weeks gestation. The most accurate results are within a 5 week period prior to delivery. The rectum and vagina are swabbed during the antepartum OB appointment and the sample is sent to the lab for processing. The results are usually available with a few days.

Rapid screen GBS tests are also available if a woman presents at a facility to deliver and has not had a GBS test completed. If a pregnant woman tests positive, treatment is considered.

Treatment

Intravenous antibiotics (usually Penicillin for non-allergic patients) are given to women who are at increased risk of having a baby who will develop GBS disease. The antibiotics help protect babies from infection, but only if given during labor. Antibiotics are administered from the onset of labor and continue every 4 hours through to delivery.

The following symptoms may indicate a higher risk of delivering a baby with GBS:

  • Labor or membrane rupture before 37 weeks gestation
  • Membrane rupture more than 18 hours prior to delivery
  • Fever during labor
  • Previous baby born with GBS
  • UTI as a result of GBS in pregnancy

If the baby is delivered via C-section and there is no labor or rupture of membranes, antibiotic treatment is not given. About 1 out of 200 babies of moms with GBS will contract the infection without IV antibiotic treatment. With IV antibiotic treatment, the incidence of babies contracting the infection is lowered to 1 in 4,000.

How GPS Affects Newborns

Early-onset GBS occurs when a baby is infected with GBS within the 1st week of life. Roughly half of babies born with GBS infection have early- onset symptoms including: sepsis, pneumonia, meningitis, breathing problems, heart rate and blood pressure instability and GI and kidney problems. In severe cases, stillbirth may result. Approximately 5% of babies with GBS infections at birth will die.

Late-onset GBS may occur after one week to several months of age. Signs of late-onset GBS include changes in your baby’s eating habits, such as feeding poorly, refusing to eat or not waking for feeding. Changes in baby’s skin, including blue, gray or pale skin due to lack of oxygen, or blotchy or red skin may also be signs of GBS. In the U.S., late-onset GBS has been the leading cause of meningitis in newborns in the first three months of life.

Prevention

Although research is continuing, there is currently no vaccine for Group B Strep infection. The best two ways to prevent GBS during the first week of a newborn’s life are:

  • Testing pregnant women for GBS bacteria
  • Giving antibiotics, during labor, to women at increased risk

For additional information, please visit: 

https://www.cdc.gov/groupbstrep/index.html or https://www.marchofdimes.org/complications/group-b-strep-infection.aspx

Don’t put your un-born baby at risk! Learn the facts and get tested!

~Tanya Mack, President

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Advisory Board Publication, Telehealth Primer: Pregnancy Care, Features Women’s Telehealth

Virtual pregnancy care spans from prenatal to postpartum care.  It incorporates a variety of telehealth modalities including audiovisual visits, remote patient monitoring and “live” and asynchronous store and forward imaging.

The Advisory Board is the best practice firm helping healthcare organizations worldwide improve their performance using a combination of research, technology and consulting. They have 12 offices on 3 continents and publish to over 9,000 healthcare organization outlets.

Recently, the Advisory Board published the piece, “Telehealth Primer: Pregnancy Care.” The publication features four innovative healthcare organizations using telehealth tools to deliver different aspects of pregnancy care and their business cases and results.

Women’s Telehealth is pleased to be featured in the primer for our work in providing maternal-fetal medicine services, delivered 100% via telemedicine, to help decrease preterm labor and improve access to maternal-fetal medicine providers.  

The Mayo Clinic’s OB Nest program and the University of Utah were also featured in the Primer for their work in delivering antepartum visits virtually vs. in-person visits, to improve patient satisfaction with the same clinical outcomes.

The Primer also featured the University of Pennsylvania for delivering postpartum visits via remote patient monitoring to ease post-delivery care and outcomes for new moms.

For a copy of this informative primer, visit: https://www.advisory.com/research/service-line-strategy-advisor/resources/2018/telehealth-primer-pregnancy-care

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High Trisomy 18 Risk: Concerns Relieved Story

Unborn baby’s high birth defect risk is the focus of this Women’s Telehealth patient story.

This Pregnancy’s Challenge: In a prior pregnancy, prenatal tests indicated positive results for Downs Syndrome for this mom-to-be. Fortunately, this proved not to be the case and her baby was indeed born healthy.  However, with the next/current pregnancy, the patient was extremely worried when “Quad Test” results [deleted: during her current pregnancy] reflected a 1:56 risk for Trisomy 18 and the ultrasound conducted at the local hospital was inconclusive.

Trisomy 18, also known as Edwards Syndrome, is similar to Downs Syndrome, as they are both caused by a chromosome abnormality. Unlike Downs Syndrome however, Edwards Syndrome is potentially more life-threatening during the neonatal period and early life. It was very important that the mother and unborn child receive high-risk OB Specialist care. 

The Team’s Actions: Because there were no MFM Specialists in the patient’s community and it was over an hour drive to the closest one in Albany, GA, the patient opted for MFM care via telemedicine through Women’s Telehealth based in Atlanta.  WT was able to offer the patient in-depth evaluation and consultations via telemedicine directly from her local OB physician’s office.

  • The patient declined amniocentesis, a procedure whereby amniotic fluid is collected for     detailed diagnostic testing and at the time, free cell DNA testing via maternal blood was not available. 
  • Advanced, serial “live” ultrasound imaging for fetal growth and well-being was performed.  
  • WT conducted regular MFM physician consultations to monitor the baby’s development.           
  • A co-management plan was developed between the WT MFM specialist and local OB/GYN.

The Results:

  • High risk monitoring continued to show no abnormalities and a healthy baby was born!
  • The family saved an est. $500 in travel expenses, not going to and from the home to Atlanta, $2000 out of pocket hospital facility fees, and over 28 hrs of commuting time.

WT’s progressive telemedicine capability, providing the right specialist at the right time, supported the patient safely through an uncertain, emotional journey. In this case, the WT team was able to allay the patient’s concerns and celebrate a positive outcome!

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Birth defects are a common, critical and costly condition affecting 1 in every 33 babies born in the U.S. each year.* For more information about birth defect stats, prevention, diagnosis and aftercare, visit: https://www.cdc.gov/ncbddd/birthdefects/facts.html

*Centers for Disease Control and Prevention. Update on Overall Prevalence of Major Birth Defects–Atlanta, Georgia, 1978-2005. MMWR Morb Mortal Wkly Rep. 2008;57(1):1-5.

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Our goal in sharing patient stories is to show the role and possibilities Women’s Telehealth plays in accessing and intervening in high risk pregnancies. We help turn patient and OB provider concern into the best possible care plans and outcomes for mom and their babies.
For more information, call our office at: 404.478.3017

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Baptist Medical Center East Partners with Women’s Telehealth to Solve MFM Gap in AL State Capital

Baptist Medical Center East in Montgomery, AL, is seeing the positive results of keeping high risk obstetric patients local after partnering with Women’s Telehealth to add maternal-fetal services via telemedicine. The hospital opened their new perinatal center in late 2018 and became the first MFM telehealth operation in the state of Alabama. Prior to opening, high risk OB patients often had to travel over 2 hour to either Birmingham or South Alabama for MFM consultation and care. In their first several months in operation, hundreds of high risk OB patients have been cared for in their home community of Montgomery.

“This partnership has allowed Women’s Telehealth to expand services into the State of Alabama,” said Tanya Mack, President of Women’s Telehealth. “It has also helped payers in Alabama to see the value that adding access to high risk OB services to telehealth brings to rural Alabama by expanding their coverage.”

Jeff G. Rains, CEO of Baptist Medical Center East reports that, “Partnering with Women’s Telehealth has allowed us to fill our maternal-fetal medicine gap while improving and advancing our obstetric service line. Since the beginning of this partnership, we have seen a significant growth in patient encounters, outcomes and satisfaction. We are proud to be able to offer this service locally and proud to be partners with Women’s Telehealth.”

For more information about Baptist Medical Center East visit: https://www.baptistfirst.org/locations/baptist-medical-center-east

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The Addis Clinic Partnership Expands Women’s Telehealth Global Footprint

Women’s Telehealth is pleased to announce the partnership with The Addis Clinic, to provide volunteer obstetric and maternal-fetal medical expertise to healthcare workers in other countries lacking high risk OB physicians. Michelle Turner, Executive Director, and Meghan Moretti, Clinical Operations Manager, The Addis Clinic, and Tanya Mack, President of Women’s Telehealth, met at the Global Partnership for Telehealth’s Conference in Georgia this past spring. They later connected at the national ATA meeting and decided to combine resources to increase access to high risk OB care through Addis Clinic’s global partner clinics and telemedicine.

The Addis Clinic is a non-profit organization that connects volunteer physicians with local organizations to provide health care to vulnerable and underserved populations around the world. The primarily locations served include sub-Saharan Africa, the Caribbean and Central America. It is estimated that there is a shortage of 4 million healthcare workers globally.

The Addis Clinic partners with medical experts willing to donate their expertise to help train frontline clinic healthcare workers thousands of miles away using an innovative healthcare communications platform.

Thus far, Women’s Telehealth has been able to remotely assist high risk OB patients and healthcare workers in Kenya for such obstetric problems as: stroke at 20 weeks gestation, uncontrolled diabetes mellitus and malaria infections in pregnant women.

For more information about The Addis Clinic visit: https://www.addisclinic.org/

Photo: Michelle Turner, Executive Director, The Addis Clinic; Tanya Mack, President, Women’s Telehealth

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