JMIR Publications

ABSTRACT

Background:

Pregnancies extending beyond the estimated date of delivery (EDD) often require repeated fetal surveillance, contributing to increased healthcare utilization. Digital health approaches enabling patient-operated remote monitoring may support more flexible models of antenatal care. This study evaluated the feasibility of a patient-operated remote fetal surveillance pathway using a smartphone-based ultrasound system in women at or beyond EDD.

Objective:

To assess the feasibility, usability, and acceptability of patient-performed smartphone-based ultrasound with remote physician review for fetal surveillance beyond EDD.

Methods:

In this prospective, single-center observational study, 50 women with singleton pregnancies ≥40+0 weeks independently performed fetal ultrasound examinations using a smartphone-coupled ultrasound device following video-based instruction only. Examinations were transmitted for remote physician review and compared with routine clinician-performed ultrasound assessments. Fetal heart activity, amniotic fluid volume, and fetal movements were assessed. Participants completed structured questionnaires evaluating usability, satisfaction, perceived safety, and anticipated impact on outpatient visit utilization.

Results:

Participants successfully obtained interpretable assessments of fetal heart activity in 92% of cases, amniotic fluid volume in 96%, and fetal movements in 100%. All routine clinician-performed scans were normal. Mean user satisfaction was 4.6/5. Most participants reported feeling safe using the system (91.9%) and indicated willingness to use it at home (97.9%). Additionally, 81.6% anticipated reduced outpatient visits with access to the system. No device-related adverse events occurred.

Conclusions:

Patient-operated smartphone-based ultrasound with remote physician review was feasible and well accepted for fetal surveillance in late-term pregnancy. These findings support further evaluation of patient-operated tele-ultrasound within digital antenatal care pathways in larger multicenter studies conducted in real-world settings.