P09.04: Remote fetal medicine consultation using video streaming

Abstract

Objective: To evaluate the use of videostreaming technique for live video telemedicine link for fetal ultrasonographic consultations. Methods: A link was established between two fetal ultrasound units in the Southern Swedish Health Care Region for consultations in cases of suspected fetal developmental abnormalities. Video compression standards MPEG1 and MPEG2 and videostreams with constant bandwidth of 1.5 Mbit/s (MPEG1) and 2 Mbit/s (MPEG2) were used. The transferred ultrasound images were discussed using regular telephone between the examiner and the expert. In cases of termination of pregnancy, the link was also used for telepathological transmission of macroscopic and microscopic images from the post mortem examination. Results: In a pilot study, the quality of ultrasound images from examination of fetuses in uncomplicated pregnancies was judged acceptable. Subsequently, the system was used for following consultations: 1. Twin pregnancy with an anencephalic fetus (24 wks); 2. Cleft-lip (29 wks); 3. Polycystic kidneys and oligohydramniosis (17 wks); 4. Hygroma and generalized hydrops with oligohydramniosis. In all four cases the quality of ultrasound images was considered excellent, fully sufficient for a reliable diagnosis and planning of the clinical management. In two cases (No. 3 and 4), the postmortem findings (polycystic kidneys with lung hypoplasia; bilateral multicystic hygroma with lymphoedema, aortic arch hypoplasia) were demonstrated by telemedicine to the clinicians at the central hospital. Conclusions: The low-cost videostreaming technique enables a fetal telemedicine service both on an immediate (on-line) and mediate (off-line transmission of video-recorded images) basis. This allows for a cost-effective access to a second opinion without a primary transfer of the patient to the regional center.