Effectiveness of TeleCTG in Reducing Neonatal Morbidity and Mortality: A Clinical Evaluation
DOI:
https://doi.org/10.47701/8x7m3y70Keywords:
Apgar score, effectiveness, neonatal mortality, TeleCTG, telehealthAbstract
Infant mortality remains a major public health challenge in Indonesia, with rates still exceeding the Sustainable Development Goals (SDGs) target. Digital health innovations, such as TeleCTG, have been introduced to improve accessibility and quality of maternal care by enabling remote fetal monitoring. This study aimed to evaluate the effectiveness of TeleCTG in reducing neonatal morbidity and mortality. A retrospective cohort design was conducted using secondary data from Puskesmas Pakutandang, involving 78 pregnant women at ?28 weeks of gestation or with risk factors. The exposure group consisted of 34 mothers who underwent TeleCTG examinations, while the non-exposure group included 44 mothers who received routine antenatal care without TeleCTG. Infant outcomes, including mortality and Apgar scores at 1/5/10 minutes, were analyzed using Fisher’s Exact Test and logistic regression with a 95% confidence interval. The results showed a significant association between TeleCTG use and reduced infant mortality (p=0.033; RR 1.158, 95% CI 1.030–1.302), while no significant effect was observed on Apgar scores <7 at 1/5/10 minutes (p=0.065). In conclusion, TeleCTG has the potential to lower infant mortality and support maternal health services, although further research with intrapartum monitoring is warranted to strengthen evidence of its effectiveness.
References
Blix, E., Brurberg, K. G., Reierth, E., Reinar, L. M., & Øian, P. (2024). ST waveform analysis vs cardiotocography alone for intrapartum fetal monitoring: An updated systematic review and meta-analysis of randomized trials. In Acta Obstetricia et Gynecologica Scandinavica (Vol. 103, Issue 3, pp. 437–448). John Wiley and Sons Inc. https://doi.org/10.1111/aogs.14752
Bobo, FT., Yesuf, EA., Woldie, M. (2017). Inequities in utilization of reproductive and maternal health services in Ethiopia. Int J Equity Health, 16(1), 1–8.
Denicola, N. (2020). Implementing Telehealth in Practice: ACOG Committee Opinion Summary, Number 798. Obstetrics and Gynecology, 135(2), 493–494.
Devane, D., Lalor, J. G., Daly, S., Mcguire, W., Cuthbert, A., & Smith, V. (2017). Cardiotocography versus intermittent auscultation of fetal heart on admission to labour ward for assessment of fetal wellbeing. In Cochrane Database of Systematic Reviews (Vol. 2017, Issue 1). John Wiley and Sons Ltd. https://doi.org/10.1002/14651858.CD005122.pub5
Freeman, R. K., Anderson, G., & Dorchester, W. (1982). A prospective multi-institutional study of antepartum fetal heart rate monitoring. I. Risk of perinatal mortality and morbidity according to antepartum fetal heart rate test results. American Journal of Obstetrics and Gynecology, 143(7), 771–777. https://doi.org/10.1016/0002-9378(82)90008-4
Gaikwad, V., Bhadoriya, A., & Gaikwad, S. (2024). A Comparative Study of Fetal and Maternal Outcomes in Registered and Unregistered Antenatal Cases in a Tertiary Care Center. Cureus. https://doi.org/10.7759/cureus.66066
Grivell, R. M., Alfirevic, Z., Gyte, G. M. L., & Devane, D. (2015). Antenatal cardiotocography for fetal assessment. Cochrane Database of Systematic Reviews, 2015(9), 1–39. https://doi.org/10.1002/14651858.CD007863.pub4
Jia, Y.-J., Ghi, T., Pereira, S., Gracia Perez-Bonfils, A., & Chandraharan, E. (2023). Pathophysiological interpretation of fetal heart rate tracings in clinical practice. American Journal of Obstetrics and Gynecology, 228(6), 622–644. https://doi.org/https://doi.org/10.1016/j.ajog.2022.05.023
Kaligis, Retor A.W., Anshari, Faridhian., Devi, S. P. (2021). Utilization of TELECTG in Empowering Midwives Through The Diffusion of Innovation Approach. Proceedings of the 4th International Conference on Communication & Business.
Kementerian Kesehatan RI. (2020). Indikator Program Kesehatan Masyarakat dalam RPJMN dan Rentra Kementerian Kesehatan 2020-2024. Katalog Dalam Terbitan. Kementerian Kesehatan RI, 1–99. https://kesmas.kemkes.go.id/assets/uploads/contents/attachments/ef5bb48f4aaae60ebb724caf1c534a24.pdf
Laksono, A. D., Rukmini, R., & Wulandari, R. D. (2020). Regional disparities in antenatal care utilization in Indonesia. PLoS ONE, 15(2), 1–13. https://doi.org/10.1371/journal.pone.0224006
Lean, S. C., Derricott, H., Jones, R. L., & Heazell, A. E. P. (2017). Advanced maternal age and adverse pregnancy outcomes: A systematic review and meta-analysis. PLoS ONE, 12(10). https://doi.org/10.1371/journal.pone.0186287
Markam, R., & Ghanghoria, V. (2024). Study of intrapartum cardiotocography and its correlation with perinatal outcome in high risk pregnancy. The New Indian Journal of OBGYN, 11(1), 79–84. https://doi.org/10.21276/obgyn.20252024.11.1.15
Miyata, K., Shibata, C., Fukunishi, H., Hemmi, K., Kinoshita, H., Hirakawa, T., Urushiyama, D., Kurakazu, M., & Yotsumoto, F. (2025). Cardiotocography-Based Experimental Comparison of Artificial Intelligence and Human Judgment in Assessing Fetal Asphyxia During Delivery. Cureus. https://doi.org/10.7759/cureus.78282
Nurrizka, RH., Wahyono, TYM. (2018). Disparitas Kematian Maternal di Indonesia: Studi Ekologi dengan Analisis Spasial. Media Kesehat Masy Indones, 14(2), 119.
Sajedinejad, S., Majdzadeh, R., Vedadhir, A. A., Tabatabaei, M. G., & Mohammad, K. (2015). Maternal mortality: A cross-sectional study in global health. Globalization and Health, 11(1), 1–13. https://doi.org/10.1186/s12992-015-0087-y
Singh, S. K., Kumar, R., Agarwal, A., Tyagi, A., & Bisht, S. S. (2022). Intrapartum cardiotocographic monitoring and its correlation with neonatal outcome. Journal of Family Medicine and Primary Care, 11(11), 7398–7405. https://doi.org/10.4103/jfmpc.jfmpc_1525_22
Soewandhie, G. H. M., Sekarwati, T. A., Darsini, N., & Husada, D. (2020). Risk Factors for Neonatal Asphyxia Occurrence at General Hospital Dr. M. Soewandhie, Surabaya. Indian Journal of Public Health Research & Development, 11(04), 866–871. https://doi.org/10.37506/ijphrd.v11i4.7757
Sri, H., Mubarokah, K. (2018). Kondisi Demografi Ibu dan Suami pada Kasus Kematian Ibu. Higeia J Public Heal Res Dev [Internet], 3(5), 99–108.
Suharmiati,S., Laksono, A., Astuti, W. (2013). UP Review Kebijakan tentang Pelayanan Kesehatan Puskesmas di Daerah Terpencil Perbatasan. Bul Penelit Sist Kesehat, 16(2), 109–116.
Susiarno, H., Agustian, D., Nurdiawan, W., Waluyo, A., Adnani, Q., & Gumilang, L. (2021). Model Pelayanan Kesehatan Maternal di Fasilitas Kesehatan Tingkat Pertama Berbasis Internet of Medical Things (Lentera Í-Met) (pp. 5–7).
United Nation (UN). (2019). The sustainable development goals report 2019. United Nations Publication Issued by the Department of Economic and Social Affairs, 64.
World Health Organization. (2019). Trends in maternal mortality: 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2019. In WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division.