# Implementing a Doctor-to-Doctor Telemedicine Network to Strengthen Rural Obstetric Care in Japan: Feasibility, Clinical Utility, and Educational Impact

## TL;DR

A telemedicine system connecting rural and university hospitals in Japan helped improve obstetric care and supported junior doctors.

## Contribution

The study demonstrates the feasibility and benefits of a doctor-to-doctor teleconsultation system in rural obstetric care.

## Key findings

- 21 teleconsultations were conducted, addressing 58 cases with a 64% local management success rate.
- Junior physicians reported over 80% benefit in decision-making, learning, and psychological reassurance.
- The system effectively managed obstetric and non-obstetric maternal conditions, fetal anomalies, and early pregnancy loss.

## Abstract

Introduction: Japan has experienced a steady decline in live births and maternity facilities, with rural areas particularly affected by shortages of obstetricians and restricted access to perinatal care. Telemedicine has been proposed as a means of bridging these gaps, yet doctor-to-doctor systems remain scarcely reported, especially in obstetrics. This study aimed to evaluate the feasibility, clinical utility, and educational impact of a doctor-to-doctor teleconsultation system linking a tertiary university hospital with a rural municipal maternity facility in Japan.

Methods: We conducted a retrospective observational study of pregnant women whose management was discussed via a teleconsultation over a 17-month period (November 2023-March 2025). Clinical data and pregnancy outcomes were reviewed. Six junior physicians who used the system completed an anonymous questionnaire consisting of seven Likert-scale items and three open-ended questions.

Results: During the study period, 21 teleconsultations were held, covering 58 cases. The main clinical issues were obstetric complications (20, 34%), non-obstetric maternal conditions (20, 34%), fetal anomalies (8, 14%), and early pregnancy loss (4, 6.9%). Management planning was the most frequent reason for consultation (47, 81%). Of 47 cases in which management was discussed, 17 (36%) were referred to tertiary care, while all 30 cases (64%) managed locally resulted in uncomplicated deliveries at the rural hospital. In the survey, more than 80% of junior physicians (5 of 6) reported benefits in clinical decision-making, learning opportunities, and psychological reassurance.

Conclusion: This pilot study suggests that doctor-to-doctor teleconsultation is feasible and clinically valuable, while also offering educational and psychological support for junior physicians, thereby serving as a practical strategy for sustaining safe perinatal care in resource-limited rural settings.