TeleICU obstetrics: a strategy to decrease maternal mortality in Brazil.

BACKGROUND

Maternal mortality in Brazil remains elevated despite local initiatives. The TeleICU Obstetric (TIO) project was created to assist intensive care units in reference obstetric hospitals.

METHODS

25 Brazilian hospitals were selected by the Ministry of Health for the TIO programme, running from April 2022 to May 2024. The programme included teletraining for multidisciplinary teams, teleinterconsultations with specialists and monitoring of maternal health indicators. Training modalities included asynchronous, synchronous and in loco formats. Teleinterconsultations were conducted between hospital professionals and the obstetrics team and intensivists from Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, available 7 days a week. The maternal mortality ratio (MMR) was calculated for the 6 months prior to the project (baseline) and for the 7 months following its implementation.

FINDINGS: Median project participation was 7 (6-10) months. Training was completed by 564 professionals (asynchronous), 1707 (synchronous) and 831 (in loco), with a Net Promoter Score of 85 (81-92), 100 (93-100) and 95 (92-100), respectively. Teleinterconsultations assisted 1351 patients across 4556 sessions. 16 hospitals provided full data for analysis. MMR reduced significantly by 45% (p<0.05), from 190 (63-346) pre-intervention to 104 (55-213) during implementation.

INTERPRETATION: The TIO project is feasible and scalable for other economically disadvantaged countries facing similar challenges to reducing maternal mortality.