Examining Ultrasound Diagnostic Performance Improvement with Utilization of Maternal-Fetal Medicine Tele-Interpretation.

BACKGROUND Telemedicine can extend essential health services to under-resourced settings and improve level and quality of obstetric care. Specifically, evaluation and management of fetal anomalies often requires perinatal subspecialists, rendering prenatal diagnosis essential, and may benefit from telemedicine platforms to improve access to care. OBJECTIVE This study examines the impact of a maternal-fetal medicine (MFM) tele-ultrasound program on diagnostic accuracy of fetal anomalies when deployed within practices where ultrasounds are otherwise interpreted by general obstetricians or family medicine physicians. STUDY DESIGN This is a cross-sectional study of all patients receiving care at eleven private obstetric practices and imaging centers who had an obstetric ultrasound performed from January 1, 2020 - July 6, 2020. All ultrasounds were performed by sonographers remotely trained under a standardized protocol and interpreted by MFM physicians via telemedicine. Ultrasound characteristics and interpretation were extracted from ultrasound reports. Prior to introduction of tele-MFM, all ultrasounds were reviewed by general obstetricians and family medicine physicians with reliance predominantly on the sonographer's impression. The primary outcome was potential missed diagnosis of a fetal anomaly, defined as an ultrasound designated as normal by the sonographer but diagnosed with an anomaly via tele-MFM. These serve as a proxy measure of anomaly diagnoses that would likely be missed without MFM supervision. Characteristics of potential missed diagnoses were compared by type of scan and fetal organ system in univariable analysis. A survey was also conducted of sonographers and in-person obstetric providers to assess perceptions of MFM ultrasound interpretation via telemedicine. RESULTS In total, 6,403 ultrasounds were evaluated, 310 of which had a diagnosis of a fetal anomaly by an MFM physician (4.8%). 43 of the anomalies were diagnosed on anatomic survey (13.9%) and 89 were cardiac anomalies (28.7%). The overall rate of potential missed diagnoses was 34.5% and varied significantly by type of ultrasound [anatomy scans versus other first, second, and third trimester ultrasounds] (p < 0.01). There were significant differences in the rate of potential missed diagnoses by organ system, with the highest rate for cardiac anomalies (p< 0.01). CONCLUSIONS MFM expertise refines diagnostic performance of antenatal ultrasound throughout pregnancy. This has implications for improving quality of antenatal care by ensuring appropriate referrals and site of delivery, particularly for cardiac anomalies.