doi: http://dx.doi.org/10.11606/issn.1679-9836.v102i4e-199087 Rev Med (São Paulo). 2023 July-Aug.;102(4):e-199087.

Review article
The applications of digital health in obstetric care: impacts and
perspectives that go beyond the COVID-19 pandemics

Aplicações da saúde digital no cuidado obstétrico: impactos e

perspectivas que extrapolam a pandemia de COVID-19

Murilo Pissinati Perez¹, Nathália Cristian Ferreira de Oliveira², Zilma Silveira Nogueira Reis3
Perez MP, Oliveira NCF, Reis ZSN.The applications of digital health in obstetric care: impacts and perspectives that go beyond the COVID-19
pandemics / Aplicações da saúde digital no cuidado obstétrico: impactos e perspectivas que extrapolam a pandemia de COVID-19. Rev Med (São
Paulo). 2023 July-Aug.;102(4):e-199087.
ABSTRACT: Introduction: The women’s welfare, as viewed as a whole
in women’s healthcare, may be exemplified as obstetric and prenatal
care, which is based on the access to health services and good quality
information. Those factors enlarge women’s empowerment, decrease
pregnancy complications and maternal-fetal mortality rate. Many
informatized systems have been driven by COVID-19 pandemics and have
become an ally in women’s healthcare and in pregnancy development, in
which telemedicine and mobile health apps have been made important
pillars on e-Health to facilitating doctor-pregnant patient relationship.
Objective: To evaluate in the literature about the impacts of digital health
system implementation and pregnancy healthcare during prenatal care
and validation of pregnant women information. Methods: It was used
the database of PubMed, SciELO, Google Scholar and BVS between
the period of 2016 and 2021, using Portuguese and English descriptors,
including meta-analysis, prospective and retrospective cohorts, as well
as case reports. Results: There were 13 selected articles that represent the
theme of obstetric healthcare, prenatal care related to digital information
and validation of pregnancy data reporting. Analyzed under the perspective
of three main areas involved in digital health applications related to
obstetric care, they were related to a better pregnancy healthcare and to
women’s empowerment tool. Discussion: The pregnancy information
validity constitutes a building up public policy tool and empowers
epidemiological research. The quality of this information and the active
pregnancy participation are essential pillars to promote mother-child
health. Besides that, educational healthcare apps have been made one
of the informatized ways by which telemedicine has become popular
among patients, it has been included as an interventional way in the
doctor-patient relationship. Therefore, healthcare obstetrics tools such
as prenatal care has been made easily acessed and diversed through
e-Health, even though during these pandemic times. Finally, the birth plan
has become an efficacious tool in the prenatal care, in which it has made
available a better communication between the pregnant woman and its
medical team, family, friends and people around her, it represents their
preferences concerning the birth time, in which it makes it an humanized
delivery. Conclusion: Through the analysis of the articles it was found
that the obstetric health information technology allows an integral and
closer care through mobile applications, in which they have improved and
diminished healthcare access barriers. Those tools allied to a consolidated
and informatized birth plan, plus the fact of sharing educational resources,
they potentiate women’s decision-making process.
KEYWORDS: Obstetrics; Digital health; Pandemic.
RESUMO: Introdução: O bem-estar da mulher, em uma visão integral do
cuidado à saúde feminina, exemplificado pelo cuidado obstétrico e atenção
pré-natal, se respalda no acesso aos serviços de saúde e à informação de
qualidade. Esses fatores aumentam o empoderamento feminino, reduzem
as complicações e os índices de mortalidade materno-fetais. Impulsionados
pelo período de pandemia COVID-19, diversos sistemas informatizados
têm se tornado aliados no cuidado à saúde da mulher e ao desenvolvimento
da gestação, sendo a telemedicina e os aplicativos em saúde pilares
importantes da e-Saúde que facilitam a interface médico-gestante. Objetivo:
Levantar evidências na literatura sobre os impactos das implementações de
tecnologias digitais na saúde e atenção à gestante durante o cuidado pré-natal
e a validação da informação gerada pela gestante. Método: Foram utilizadas
as bases de dados PubMed, SciELO, Google Scholar e BVS no período de
2016 a 2021, com descritores em português e inglês, incluindo artigos de
revisão, meta-análises, coortes prospectivas e retrospectivas, assim como os
relatos de caso. Resultado: Foram selecionados 13 artigos representando os
temas da atenção à gestante, cuidados pré-natal relacionados às tecnologias
digitais e validação da informação da usuária. Analisados sob a perspectiva
de três grandes áreas envolvidas na aplicação da saúde digital ao cuidado
obstétrico, resultaram em uma relação de maior cuidado à saúde da gestante,
além de disponibilizar ferramentas de empoderamento feminino Discussão:
A validação da informação da gestante constitui uma ferramenta de fomento
às políticas públicas e pesquisas epidemiológicas. A qualidade dessa
informação e a participação ativa da gestante são pilares importantes para
a promoção de saúde materna-infantil. Ademais, aplicativos educativos em
saúde tem sido uma das formas informatizadas pela qual a telemedicina se
populariza dentre os pacientes, inclusive como meio intervencionista nas
relações médico-paciente. Assim, ferramentas de saúde obstétrica como o
pré-natal se tornaram mais acessíveis e diversificadas, mesmo em um período
de pandemia, por meio da e-Saúde. Por fim, o plano de parto mostra-se uma
ferramenta eficaz no pré-natal, facilitando a comunicação da gestante com
a equipe médica, familiares e amigos, acerca das suas preferências quanto
ao processo de parto, estimulando a mulher a ser protagonista de seu parto,
humanizando-o. Conclusão: A análise das publicações avaliadas aponta
que as tecnologias de informação na área de saúde obstétrica permitem um
cuidado integral e próximo por meios eletrônicos como aplicativos digitais,
melhorando a atenção e diminuindo barreiras de acesso aos serviços de
saúde. Aliadas a um plano de parto consolidado e informatizado, além de
partilharem conteúdos educativos, essas ferramentas ainda potencializam o
poder de decisão feminino.
PALAVRAS-CHAVE: Obstetrícia; Saúde digital; Pandemia.

1. Acadêmico de Medicina da Universidade Federal de Minas Gerais – UFMG, Belo Horizonte (MG), Brasil; murilo.pperez@hotmail.com; ORCID https://
orcid.org/0000-0002-1218-6792. Lattes http://lattes.cnpq.br/8695915433804621.
2. Pesquisadora Independente; nat.cristian@hotmail.com; Belo Horizonte (MG), Brasil; ORCID: https://orcid.org/0000-0002-7491-7335; Lattes: http://lattes.
cnpq.br/5387033375735667.
3. Professora Associada do Departamento de Ginecologia e Obstetrícia, do Programa de Pós-graduação em Saúde da Mulher da UFMG e Médica do Hospital
das Clínicas - UFMG, Belo Horizonte (MG), Brasil. https://orcid.org/0000-0001-6374-9295; http://lattes.cnpq.br/5695664808243549
Correspondence: Murilo Pissinati Perez. Rua Maranhão, 182, apto 502, Belo Horizonte (MG), Brasil. CEP 30150-330. Email: murilo.pperez@hotmail.com.

1
Perez MP, Oliveira NCF. The applications of digital health in obstetric care: impacts and perspectives that go beyond.
INTRODUCTION
H istorically, the understanding of the states
involved in health-disease processes has
undergone modifications, in line with social and scientific
evolution. Contrary to the view centered on disease control,
a broad debate on new determinants of human health
was instigated worldwide in the 1960s. This formalized
movements that converged in the resignification of health,
such as the Alma-Ata Conference and the family health
strategy. World Health Day (April 7, 1948) was marked by
the establishment of the global right to health and the role
of the State in providing health promotion and protection.
At the International Conference on Primary Health Care,
WHO recognized: “Health is a state of complete physical,
mental and social well-being and not merely the absence
of disease or infirmity - is a fundamental right, and the
attainment of the highest possible level of health is the
most important worldwide social goal, whose realization
requires the action of many other social and economic
sectors in addition to the health sector”¹.
The technical perspective of health gradually
underwent a process of humanization. The care of
special segments of the population accompanied this
transformation. The maternal-child programs in force
until the 1970s reflected the strict view of women’s
health with a focus on the pregnancy-postpartum cycle,
disregarding important aspects of women’s well-being.
Still on the rise, comprehensive care for women’s health
was inaugurated in the Comprehensive Women’s Health
Assistance Program, elaborated in 1984 by the Ministry
of Health1,2,3,4,5.
Notably, attention to women, mainly in the obstetric
field - given the enormous complexity of the gestational,
prenatal and postpartum periods - became the focus of
debates on the humanization of medicine6. In conformity
with the principles of the Unified Health System (SUS)
and the new ideals of medicine, prenatal care has proven
to be an important tool for health promotion, disease
prevention, and education, which justifies the impulses
of the governmental sphere to guarantee the expansion of
access and quality of care.
The Ministry of Health (MS) instituted, in 2000,
the Humanization Program in Prenatal and Birth (PHPN)
in SUS, aiming to develop actions for the promotion,
prevention, and assistance of pregnant women and
newborns’ health. Among these actions, those focused on
prenatal care have shown enormous impact on maternal
and neonatal health, resulting in increased access to
quality information and female empowerment, reduced
rates of cesarean delivery, and maternal mortality7.
Around 10% of Brazilian pregnant women had no
prenatal care coverage in Brazil in 1995. In 2015, 2.2% of
pregnant women were not benefited from prenatal care,
according to data from the Live Births Information System
2
(Sinasc)7. From this perspective, it can be noted that there
are still obstacles to the full care of pregnant women.
Procedures for the prevention of nutritional deficiencies,
vaccinations, and the frequency of recommended prenatal
consultations are some deficient points in public attention
to Brazilian pregnant women. For pregnant women living
in rural areas, such gaps are even more relevant, leading
to inadequate family care8,9.
As a way to mitigate geographic barriers and other
situations that make it impossible for pregnant women
to attend in-person appointments (such as the necessary
social isolation during the COVID-19 pandemic),
computerized tools have emerged in the e-Health scenario
with the aim of disseminating health education, answering
questions, improving the relationship between the family
and the health team, and ensuring the bond between
women and healthcare services. E-Health, considered a
worldwide health information strategy and policy, seeks
to adopt technologies to improve individuals’ global well-
being and health, implementing concepts such as the
Internet of Things, Artificial Intelligence, Big Data, and
Data Analysis10.
An important pillar of e-Health is the telemedicine.
During the COVID-19 pandemic, telemedicine grew
exponentially and gained prominence. Regulated in
Brazil, it provides remote health care services, allowing
medical assistance. Cybermedicine aims to study the
relationship between health and the internet, aiming to
integrate new technologies, such as smartphone apps, into
human health under the name of e-health. Computerized
resources compose the object of study of health
informatics, an interdisciplinary area that aims to expand
access to primary and secondary care through information
and communication technologies10.
Digital inclusion proves to be a promising tool
for prenatal care, contributing to essential processes for
women’s health and pregnancy development. Positive
points highlight computerized tools, including data
generation for effective public policies, the popularization
of access to prenatal care, maternal empowerment through
education, and the prevention of maternal and fetal
harm5,7. The democratization of information and digital
inclusion facilitates the widespread use of tools that
bring benefits and promote equal and universal autonomy
among users10.
OBJECTIVE
To gather scientific evidence in the literature about
the impacts of the implementation of digital technologies
on health promotion and prenatal care, as well as the
validation of information generated by pregnant women.
METHODS
For this review, the databases PubMed, SciELO,

and Google Scholar, and BVS were used in the period
from 2016 to 2021, with descriptors in Portuguese
and English. A search was made for original articles,
descriptive and experimental studies, review articles
including meta-analyses, prospective and retrospective
cohorts, as well as case reports. The keywords used for
Source: authors
Figure 1 - Flowchart of the addressed articles
RESULTS
According to the methodology, the articles were
selected based on the objective, respecting the inclusion
criteria and proximity to current times. Thus, articles prior
Table 1 - Studies on digital tools influencing prenatal care, maternal health attention, and respective validation of information.
Authors/
year
Validation of maternal reports for low
Chang et al.,
birthweight and preterm birth indicators
201811
in rural Nepal
Can surveys of women accurately track
indicators of maternal and newborn McCarthy et
care? A validity and reliability study in al., 201612
Kenya
Rev Med (São Paulo). 2023 July-Aug.;102(4):e-199087.
the search were “Pandemic”/”Prenatal”/”Virtual”/”Tele
health”/”Telemedicine”/”Pré-natal”/”distancing”/”Pand
emia”/”COVID-19”/”Telemedicina”/”Distanciamento”.
Articles that mentioned the relationship between health
informatization and prenatal aspects were prioritized as
inclusion criteria.
to 2016 were excluded. In total, 13 articles were selected, all
representative of the theme of attention to pregnant women,
prenatal care related to digital technologies, and validation
of user information. As shown in Table 1, the studies were
divided by author, year, study type, and objective.
Type of Study Main aspects
Cross- To evaluate whether the extent of the recall period of newborn
sectional weight and gestational age measures reported by mothers affects the
population classification of the neonate as low birth weight or preterm.
To evaluate how accurate is maternal reporting regarding
interventions on the newborn that occurred during the intrapartum
and immediate postpartum periods. We also examined the extent
Observational
to which there is a deterioration of this memory and how much it
longitudinal
compromises the validity of maternal reporting. In addition, we
surveyed the factors that influence maternal ability to report events
related to childbirth.
continue
3
Perez MP, Oliveira NCF. The applications of digital health in obstetric care: impacts and perspectives that go beyond.

continuation
Authors/
Type of Study Main aspects
year
Exploring the Use of Telemonitoring for
Explore the use of telemedicine in high-risk patients for hypertensive
Patients at High Risk for Hypertensive
Aquino et al., Narrative disorders in pregnancy during labor and the postpartum period. In
Disorders of Pregnancy in the
202013 review addition, evaluate the latest interventions to be used by medicine for
Antepartum and Postpartum Periods:
managing these cases.
Scoping Review
Assess the accuracy of pre-gestational information on weight,
Validity of self-reported weight, height,
Araújo et al., height, BMI, and weight at the last prenatal appointment reported by
and BMI in mothers of the research Birth Descriptive
201714 pregnant women in different sociodemographic realities and prenatal
in Brazil
variables.
A new prenatal model was designed based on 8 consultations, which
Peahl AF,
Prenatal care redesign: creating flexible included: one in-person visit for ultrasound, four in-person visits, and
Smith RD,
maternity care models through virtual Prospective four virtual visits (in the 4-1-4 prenatal scheme), in order to explore
Moniz MH.,
care. the possibility of implementing a new patient-centered prenatal care
202018
in the context of the coronavirus pandemic and beyond.
The primary objective of the study was to test the effectiveness of
A Mobile Prenatal Care App to Reduce
Marko, et al., a mobile app to facilitate and reduce in-person visits in low-risk
In-Person Visits: Prospective Controlled Prospective
201919 prenatal care without reducing the satisfaction of the pregnant woman
Trial.
with the health care provided.
This study presents an analysis of the Birth Plan database as a
Fonte de informação digital na área da Matos FF., source of digital information. Four attributes will be analyzed in
saúde: um estudo de atributos de planos Souza RR., Literature order to demonstrate the importance of the information source for
de parto informatizado para recuperação Reiz NSZ., review information retrieval and decision making. Thus, the study will
da informação. 201720 simulate information that is relevant for researchers and healthcare
professionals to contribute to the validation in a real situation.
The study aimed to develop a mobile application for smartphones as
Randomized
Aplicativo para dispositivo móvel como Souza a tool to improve adherence to prenatal appointments, validate the
controlled
ferramenta de adesão de gestantes ao CLMF., app by experts in the fields of women’s health and information and
trial (doctoral
pré-natal. 201923 communication technology, and evaluate the efficacy of the mobile
thesis)
app in improving adherence to prenatal appointments.
Amador SFJ,
Cybersaúde: importância do
Garcia FL, Collect evaluations for mobile apps designed for pregnant women
desenvolvimento de aplicativos para Descriptive
Yamaguchi and prenatal care.
gestante.
UM., 201924
Intervenção Educativa no Cuidado Present a mobile application designed for women during pregnancy,
Reis et al.,
Obstétrico através de um Aplicativo para Prospective childbirth, and postpartum, as well as the results of its dissemination
201825
Dispositivos Móveis: APP Meu Pré-natal in society.
Development and Testing of the
The objective of the study is to outline a method based on a mobile
MyHealthyPregnancy App: A
Krishnamurti Longitudinal app utilizing medical communication as a tool to decrease rates
Behavioral Decision Research-Based
et al., 201726 prospective of preterm birth in pregnant populations with low engagement in
Tool for Assessing and Communicating
prenatal care.
Pregnancy Risk.
Whittington The study defines the application of telemedicine in improving the
JR, obstetric care routine during the prenatal and postnatal periods.
Telemedicine in Low-Risk Obstetrics Ramseyer Prospective Additionally, it evaluates how this improvement can provide support
AM, Taylor for healthcare professionals in rural regions, increasing patient and
CB., 202027 professional satisfaction with the care provided.
Análise de dados na saúde obstétrica: In a practical way, the characteristics of Birth Plans data will be
um estudo de dados para captura de Reis Z., et Literature presented, which can support healthcare professionals in clinical
características e padrões em documentos al., 202031 review decision-making and researchers in understanding the characteristics
de planos de parto automatizado of birth plans registered by pregnant women.

DISCUSSION postpartum, it consists of many intrinsic aspects of the

Validation of Pregnant Women’s Information
The gestational period is of great importance in
a woman’s life. Divided into prenatal, childbirth, and
moment. Attention to the health of the mother and child
is essential and needs to encompass and care for all
these aspects, with the aim of promoting maternal-fetal
well-being and reducing the possibility of gestational
complications. However, there are obstacles to obstetric
support, resulting from factors such as the fragmentation

4

of health systems and reduced access to services. In
addition, there is a loss in generating information that
contributes to the implementation of effective health
programs based on epidemiological research. In countries
with high rural demographics, such as Nepal, where many
births occur at home, the problem becomes more serious:
low birth weight is common, as well as the occurrence
of cerebral palsy, and lack of access to support services
for pregnant women culminate in complications related
to pregnancy and childbirth and contribute to the lack of
reliable data that could underpin public policies. Thus,
maternal reporting parameters may underestimate and
bias the rates of low birth weight and preterm births,
especially in locations with a high prevalence of low birth
weight and premature births¹¹.
The reliability of the information provided by
pregnant women is influenced by their memory. Therefore,
there is concern regarding the moment when maternal
recollection is needed and the accuracy of the experience
report. Overall, there is not a significant deterioration in
the ability to recall maternal aspects and interventions in
the newborn with accuracy by mothers5,7,12, but there is a
moment in which this report can be affected, especially
when related to physical and emotional turbulence, such
as that which occurs at the beginning of labor and in
immediate postnatal care (both maternal and neonatal)¹².
The quality of information provided by pregnant
women is not the only important aspect in prenatal care,
but their active participation also has an impact on the
course of pregnancy. With the creation of validated
monitors for blood pressure measurements, there is greater
access to reliable tools and therefore greater reliability in
the generated data. It is recommended by the WHO that
pregnant women have constant home monitoring of their
blood pressure in order to maintain their own records
to improve continuity and quality of care13. Therefore,
the impact of pregnancy and fetal outcomes shows that
the self-monitoring group experienced a significant
difference in higher probabilities of spontaneous delivery
and lower probability of induction of labor compared to
the group that did not have self-monitoring10,13. However,
this approach cannot be generalized to all comorbidities,
as other comorbidities such as gestational diabetes did not
benefit in the same way, demonstrating that self-monitoring
tools have limited impacts on maternal health outcomes.
Additionally, there are several barriers that influence
the adoption of this measure, ranging from financial
limitations to limitations in human resources, including
costs, equipment availability, lack of compensation for
health professionals for guidance, among others10,13.
Another aspect of great relevance regarding the
evaluation of the quality of information generated by
pregnant women is the socioeconomic factor. Regions
with higher educational indices, private services, greater
access to information, and higher economic indices
5
Rev Med (São Paulo). 2023 July-Aug.;102(4):e-199087.
presented better results for the validation of anthropometric
variables, as evaluated in the accuracy of pre-pregnancy
weight, height, pre-pregnancy BMI, and weight at the last
prenatal consultation reported by women14. In this sense,
BMI is considered one of the most relevant indicators for
monitoring the nutritional status of pregnant women, as
recommended by the Institute of Medicine, which also
considers the index to support guidelines in pregnant
women. To validate this information, women who had
the gestational card, from which reference values (gold
standard) were obtained for the variables: pre-pregnancy
weight in kilograms (kg), height in centimeters (cm),
weight at the last consultation (kg), and pre-pregnancy
BMI obtained through the formula [pre-pregnancy weight
(kg) / height² (m²)], were considered eligible, comparing
this data with data collected in face-to-face interviews
with postpartum women during hospitalization14,15,16.
Aplicativos Atuantes no Processo de Informação em
Saúde
The COVID-19 pandemic has brought
technological changes and new ways of interaction
among people. This is no different in obstetrics and care
for pregnant women17. Several changes have influenced
the doctor-patient contact, creating a more computerized
world and other ways of social interactions, mainly
through new means of communication, with emphasis
on the empowering action of the internet. In addition,
it is notable the possibility of adopting alternative plans
using telemedicine as a modern and interventional tool
in doctor-patient relationships. Regarding women’s care,
obstetrics has become able to reinvent certain stages
of prenatal care, which have not changed since the
1930s18. These factors have initiated discussions about
the necessary number of prenatal visits and the use of
computerized tools as support to ensure the satisfaction
of pregnant women, as well as the reduction of risks and
pregnancy-related complications15,18.
The fundamental nature of prenatal care is
indisputable. It allows for the execution of actions related
to the promotion, prevention, and assistance of the health
of pregnant women and newborns, in accordance with the
Programa de Humanização no Pré-Natal e Nascimento
(PHPN), which was implemented within the scope of the
Unified Health System (SUS) in June 20007. The PHPN
established minimum care practices for the moments before
and after childbirth, such as early detection of pregnancy
(up to 120 days from the date of the last menstrual
period); at least six follow-up consultations, preferably
one in the first trimester, two in the second, and three
in the third trimester of pregnancy, and one postpartum
consultation (up to 42 days after delivery); educational
activities, among others. It is essential to remember these
concepts in the current scenario, since the advent of health
Perez MP, Oliveira NCF. The applications of digital health in obstetric care: impacts and perspectives that go beyond.
computerization creates flexible tools, accompanied by an
anticipatory guide and psychosocial support, which allow
pregnant women to shape their remote and face-to-face
care according to their needs. There are plans that address
the theme of “4-1-4,” which consists of 4 live visits, 1
ultrasound, and 4 virtual visits7,18. The idea of ​​flexibilizing
the number of prenatal visits through remote support aims
to promote greater convenience for pregnant women, but
above all, it aims to make greater availability of face-to-
face attention possible for pregnant women who are at
high risk and require closer and in-person monitoring.
Another adopted approach is the universalization
of access to education related to care practices for
pregnant women, as well as information about the process
of pregnancy and the moments of prenatal, childbirth,
and postpartum, through computerized tools. As a result,
pregnant women become protagonists in decisions
related to childbirth, as well as acquiring knowledge.
Virtual prenatal models have the potential to promote an
educational environment in content and personalized by
low-risk pregnant women in order to increase adherence
to prenatal care by reducing the need for live visits,
encouraging self-monitoring19.
The Babyscripts application illustrates this
proposal, as it provides educational content through
a mobile app and allows remote monitoring of blood
pressure and weight by the pregnant woman herself, thus
avoiding low-need obstetrician visits, optimizing time and
facilitating the life of the pregnant woman. A controlled
study compared the satisfaction of pregnant women from
the separation into two groups: the first in usual prenatal
care and the second in reduced in-person visits to the
health service, but with the use of a prenatal care app
for smartphones. The women selected to compose the
groups were between 18 and 40 years old, had a desired
pregnancy, not considered high risk, and regularly used
an Android or iOS smartphone. Among the 88 patients
chosen in an academic center in Washington, DC, United
States, 47 were submitted to the experiment and 41 formed
the control group. For the experimental group, the average
number of obstetric consultations during pregnancy was
7.8, while for the control group, the average was 10.2.
There was no statistically significant difference in the
satisfaction of women in the two groups19.
In addition, another relevant aspect regarding the
use of computerized tools for prenatal care is the increase
in adherence rates to appointments. It is well known
that low adherence of pregnant women to prenatal care
makes it difficult to detect and manage complications
of the pregnancy and postpartum period, which is
reflected statistically in maternal mortality20. With the
aim of reducing negative outcomes during pregnancy,
the World Health Organization (WHO) proposed, as
a recommendation to improve the quality of prenatal
care, increasing the number of appointments, raising
6
the minimum number to eight. Similarly, it is of great
importance to ensure that the core of prenatal care is based
on the principles of care, education, and counseling7,20,21,22.
Telemedicine helps improve low-complexity
obstetric care for the pre- and postnatal periods, as it
provides support for healthcare professionals in rural
regions, and this tool influences patient satisfaction
with care. No significant risks were observed for the
mother or fetus with a reduction from 14 to 9 prenatal
visits with interspersed virtual visits from advanced
practice nursing. During these visits, patients were
instructed to measure blood pressure and use handheld
fetal Doppler to monitor pregnancy progress. However,
there are some complicating factors, such as difficulty
of access and quality of connection, and the selection
of the videoconferencing platform is crucial for overall
patient and family satisfaction with the ease of use of the
applications21,23,24.
From this perspective, technological and
computerized tools, when applied to the health sector,
are allies of healthcare professionals. They prove to be
effective when promoting health and preventing health
problems, as exemplified by the Healthy Pregnancy app,
which aims to increase adherence to prenatal visits. The
main idea of the apps is to supplement the health services
offered in the network, rather than replace them. Therefore,
the goal of this particular app is to be associated with
monthly check-ups, presenting a significant improvement
in prenatal care adherence23.
Another important communication channel is
the “Meu pré-natal” app, which was developed with an
educational purpose to support women during pregnancy,
childbirth, and postpartum. A user interface marker is
the gestogram (a tool that calculates the chronology
of pregnancy), whose importance is justified by the
enormous relevance of neonatal death as an outcome of
premature births. The calculation of the probable date
of delivery is the reference for scheduling the ideal date
for birth, calculated from the date of the last menstrual
period reported by the pregnant woman and the first-
trimester ultrasound. From this date, the calculation of
gestational age in completed weeks and days is made. In
addition to this estimate, the pregnant woman has access
to specific knowledge related to pregnancy, caring for
her health and the newborn in easy language, becoming
the protagonist of her pregnancy. The impact observed in
society was rapid, with the popularization of the app in
several countries, demonstrating the importance of this
communication channel for health education proposals.
At that time, it was difficult to infer about educational
interventions such as guiding the search for maternity
care, or alerts for abnormalities or even if the photo album
interfered in the couple’s experience, given that the app
had been available on the market for a short time25.
The proposal to recruit pregnant women with

harmful behaviors to encourage the abandonment of
habits such as smoking, alcohol consumption, and
excessive weight gain has not yet established efficacy.
However, the use of an application with this purpose,
“myHealthyPregnancy,” for assessing patients’ risks of
preterm birth and subsequent communication of risks
to them, had a qualitatively greater impact on pregnant
women in terms of satisfaction, as they had more
prenatal consultations and even increased intention of
breastfeeding with greater attendance21,26.
The High Risk Pregnancy Program offers a website
with guidelines for routine and complicated obstetric
and neonatal topics, a center to provide patient support,
24-hour access to maternal-fetal medications, and
education consultations to improve the readiness of rural
professionals to manage emergencies. A recent patient
survey of the High Risk Pregnancy Program observed
a satisfaction rate of 98.8% and 95% and indicated that
they would use the service in the future. Furthermore,
providers who utilized the service noted greater access
to care (97.1%), improvements in patient’s lives (92.5%),
and that the system is “excellent” (98.5%)27,28,29,30.
The Birth Plan as a Tool in Prenatal Care
The strategy of using the Birth Plan (BP)
emphasizes the woman’s participation in childbirth, which
is a document or form in which the expectations and
preferences of the pregnant woman regarding childbirth
procedures are described. Introduced in the early 1980s in
the United States, the BP has been recommended by the
WHO since 1996, and since then Brazilian entities have
been working to include it in legislation.
Through this tool, the pregnant woman can register
her preferences and they are shared with the medical
team, family, and friends. Evaluating the data from the PP
helps healthcare professionals in clinical decision making
and facilitates greater satisfaction for the pregnant woman
regarding her childbirth experience. Based on the analysis
of various characteristics of a sample of PP, there are some
preferences among pregnant women regarding childbirth:
“vaginal” delivery is the preferred delivery route; age and
number of previous pregnancies are related to the chosen
delivery route; most pregnant women want to breastfeed
their child in the first moment after the baby’s birth;
most want to have a companion present during delivery;
just over half of pregnant women want anesthesia; the
majority do not want an episiotomy. Other attributes have
also been explored in the PP, such as pain management
during childbirth.
With the evolution of technology and
computerization, applications have been adapting the
Birth Plan (PP) for virtual platforms and promoting its
use. Thus, in addition to being a way to document the
desires of pregnant women, the PP also serves as a tool
7
Rev Med (São Paulo). 2023 July-Aug.;102(4):e-199087.
for generating data in the healthcare field, aiding in
the construction of a collection of structured medical
information for research and other purposes, proving
that information sources have potential to be useful
and usable for clinical practice, as well as serving
as evidence and tracking for the advancement of
medicine10,31.
Interoperability has the characteristic of
exchanging information between systems, facilitating
both the patient experience and the function of primary
care in managing levels of care. The Electronic Health
Record (EHR), as a repository of health information,
becomes capable of being processed, retrieved,
recorded, and manipulated electronically when included
in a system, the Electronic Health Record System
(EHR-S), storing patient information and enabling
the exchange of such information among the different
components forming the health system. Similarly, the
PP can be accessed from different platforms, ensuring
access by other professionals to the pregnant woman’s
demands and preferences, regardless of the location of
her care or delivery, and her longitudinal care provided
from prenatal care to the postpartum period.
Furthermore, the need for an interdisciplinary
team is considered essential, where the medical-
scientific basis is provided by the healthcare
professional, while the technical knowledge and digital
apparatus modeling demand fall within the scope of
computer science. In addition to these skills, there is the
delineation of platforms, structuring and development
of applications, which are the responsibility of design
teams and potentially the area of program architecture.
Other professionals are also important, depending on
the characteristics of the various projects.
The use of health information technologies becomes
an ally in the strategy to improve the quality of care
offered to pregnant women, ensuring their registration,
integral and continuous care, approximation between
primary care and maternity, promotion of educational
actions, encouragement of good practices in childbirth
and obstetric clinical error reduction. In addition,
stimulating the direct participation of the pregnant
woman in the decisions about her childbirth is one of
the pillars of humanization of childbirth, making the
woman the protagonist of her pregnancy moment.
By involving family and people in contact with the
pregnant woman, there is a greater overall satisfaction
of the patient and her related ones, influencing the
improvement of obstetric care.
The pregnant woman’s perception of the
communicability of the birth plan on a digital platform
was found to be positive, influencing the physician-
patient interaction, reducing medicalization, and
empowering the pregnant woman to participate in her
own childbirth process. The early involvement of the
Perez MP, Oliveira NCF. The applications of digital health in obstetric care: impacts and perspectives that go beyond.
pregnant woman in the development of the platform to
be used by herself helps to engage and adhere to its use,
as well as resolving problems early on.
Although early perceptions and impacts in the
short term are favorable, the scientific literature still lacks
studies that evaluate the results of implementing digital
health in obstetric care. Thus, one of the limitations of this
study was based on the limited number of concrete studies
on long-term impacts. Additionally, the pandemic period,
which is included in the analyzed time interval, poses a
hindrance to technological production and evaluation,
even though it is a motivating factor for digital health.
Therefore, it is suggested to monitor digital technologies
over time in order to improve them and verify the
outcomes of their applications.
Authors’ participation:
The research had the participation of Murilo Pissinati Perez as a moderator in the selection of articles and in the construction of
objectives, methods, as well as in the writing of the discussion and carrying out of the article review. The participation of Nathália
Cristian Ferreira de Oliveira, who contributed to the construction of the introduction, abstract, results, conclusion, and formatting of
the edition. In addition to the guidance and final review by Zilma Silveira Nogueira Reis.
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