# Teleultrasound in obstetrics: A systematic review and meta-analysis

## TL;DR

This study reviews the use of teleultrasound in pregnancy care, finding it feasible, accurate, and acceptable, especially for high-risk patients and in rural areas.

## Contribution

The paper provides the first comprehensive systematic review and meta-analysis on the feasibility, accuracy, and cost-effectiveness of teleultrasound in obstetrics.

## Key findings

- Teleultrasound is non-inferior to conventional ultrasound for identifying fetal structures in most cases.
- Patient-operated and novice-led teleultrasound show promise for improving access in low-resource settings.
- Diagnostic accuracy is high, with an AUC of 0.93, though specialized anatomy visualization remains challenging.

## Abstract

Ultrasound is a common diagnostic modality in obstetrics to evaluate the fetal condition, frequently used in pregnant women classifying as high-risk. Modifications to guidelines, implementation of national initiatives, combined with an aging obstetric population has led to an increased number of high-risk patients. This places a substantial strain on outpatient obstetric services to accommodate the increased demand for serial antenatal ultrasound scans.

Recent advancements in digital technology have enabled the swift innovation of teleultrasound development. The recent pandemic has also substantially influenced technological development, as obstetric services considered alternative solutions to healthcare provision standards. This review aims to assess whether teleultrasound is feasible, acceptable, diagnostically accurate, and cost-effective for antenatal care.

We searched MEDLINE, Embase, Cochrane Database of Clinical Trials (CENTRAL), Web of Science, and PubMed databases from inception to December 2025. Primary research studies evaluating the feasibility, diagnostic accuracy, clinical utility, educational utility, acceptability, and economic viability of antenatal teleultrasound usage were included. Random effects meta-analysis was used, and results were reported as pooled proportions or risk ratio (RR) with 95% confidence interval (CI). Diagnostic accuracy was further assessed using a hierarchical summary receiver operating characteristic model.

Of the 6,561 papers screened, 71 studies (60 clinical observational studies, five qualitative studies, four economic evaluation studies, and two randomized controlled trials) were included. Image transfer was feasible for both synchronous and asynchronous teleultrasound transmission, in a wide range of settings. Adequate technological infrastructure, including appropriate bandwidth and framerate requirements were vital factors for sufficient image quality and minimizing transmission delays. Visualizing gross fetal and placental structures using teleultrasound was frequently high; however, more specialized anatomy such as cardiac and neurological demonstrated lower visualization rates. Overall meta-analysis of 20 anatomical structures demonstrated teleultrasound is non-inferior at identification versus the reference standard RR 1.02 (95% CI [1.00,1.03]; n = 4 studies). Pooled diagnostic accuracy demonstrated excellent performance, with an AUC of 0.93 (n = 8 studies). The overall sensitivity was moderate at 0.70 (95% CI [0.44,0.84]), with a low false positive rate of 0.03 (95% CI [0.01,0.12]). There was evidence of educational and clinical utility for obstetric teleultrasound, particularly with novice users, demonstrating improved access to care in rural areas and low- and middle-income countries. Patient-operated telesonography demonstrated feasibility and high acceptability for performing basic fetal assessments. Three-dimensional, four-dimensional, and robotic teleultrasound did not highlight superiority to two-dimensional scanning. Patients and provider acceptability was high, citing benefits in relation to satisfaction, confidence, economic savings, and balancing healthcare equity. Teleultrasound implementation costs can be high, but were frequently accrued due to monthly savings. High-quality studies were underrepresented, suggesting a need for further research. The reporting of clear methodological and technological capabilities of the teleultrasound systems represent the main limitations, proving difficulty to replicate studies adequately.

This review demonstrated the potential applicability and value of obstetric teleultrasound. This novel care model is everchanging and new devices/systems capable of telesonography are of clinical and scientific relevance. Presently, additional high-quality evidence is required, particularly using teleultrasound in a clinical context, whilst ensuring sufficient methodological detail and consistent outcome reporting.

Advancements in digital medical technology combined with the increased access to smartphones, virtual video communication, and wireless internet have enabled the swift innovation of obstetric teleultrasound development.

Despite the rapid developments of digital teleultrasound innovations in obstetrics, the collation of available evidence, particularly assessing feasibility, diagnostic accuracy, acceptability, and economic burden is minimal and thus requires thorough exploration.

We conducted a systematic review and meta-analysis of 71 studies across 27 countries. Teleultrasound image transfer was feasible for a range of teleultrasound technologies. The identification of fetal structures using teleultrasound were frequently non-inferior compared with conventional ultrasound for a range of clinical indications, whilst the diagnostic accuracy of obstetric teleultrasound was high.

Teleultrasound usage by novice users with associated tele-mentoring has clinical and educational utility, particularly in low- and middle-income countries whereby the current accessibility of ultrasound can be improved.

Patient-operated teleultrasound is a promising novel modality. However, currently, only a basic fetal assessment can be achieved. three-dimensional, four-dimensional, and robotic teleultrasound have limited scope and superiority over conventional ultrasound.

Initial overall costings of teleultrasound may be high but frequently reclaimed back due to savings when compared with standard antenatal care. Acceptability was high for both patients and service providers.

This review has demonstrated the potential applicability and value of teleultrasound for obstetrics across a range of outcomes. This novel care model is everchanging and new ultrasound devices capable of telesonography are of clinical and scientific relevance.

Currently included literature was of high risk of bias and limited in the reporting of clear methodological detail, consistent outcome reporting, and technological capabilities of the teleultrasound systems.

The reporting of essential regulatory and technological standards such as data encryption, patient confidentiality, liability in cross-jurisdictional teleultrasound use, bandwidth requirement, and transmission delays/failures is required to ensure a global assessment of obstetric teleultrasound functionality.

Given recent advancements in digital technology, Jack Le Vance and colleagues assess whether teleultrasound is feasible, acceptable, diagnostically accurate and cost effective for antenatal care.