Table 2. Key telehealth management points for high-risk pregnancies.

High-risk condition	Key management points
Hypertensive disorders of pregnancy	• A home blood pressure cuff is a key resource for management • Vital signs can be measured at fetal testing and growth ultrasounds • Weekly in-person visits may be preferable from 36 wk gestation
Diabetes (pregestational and gestational)	• Diabetes education may occur with dietician, diabetes educator, and provider via video visits • Video and online diabetes information can be sent to the patient for review • Remote monitoring of blood glucose with weekly email or phone review is recommended • Vital signs can be measured at fetal testing and growth ultrasounds
Cardiovascular disease	• A home blood pressure cuff is a key resource for management as is having a home scale to measure weight • In-person visits may be preferred from 34 wk gestation • Co-management with a cardiologist with monthly virtual visits for higher-risk diagnoses may be indicated • One or more maternal echocardiograms may be indicated during the pregnancy
Neurologic conditions	• Co-management with neurologist with virtual visits in the first and third trimester may be indicated • A family member may be helpful in assisting with a virtual neurology exam • Concerning neurologic symptoms require prompt in-person evaluation
History of preterm birth and poor obstetrical history	• Absent a cerclage, cervical length screening should continue as indicated • If a cerclage is present cervical length screening may be discontinued • There should be a low threshold for in-person evaluation of concerning symptoms • Modifications of fetal testing for prior stillbirth are not recommended
Fetal conditions (IUGR, congenital anomalies, and multiple gestations)	• A home blood pressure cuff is a key resource for management • No modification of fetal testing is recommended for conditions with increased risk for stillbirth • Patient privacy related to termination counseling may be a particular concern during telehealth visits • In-person visits can be coordinated with fetal testing and ultrasounds
Genetic counseling	• Counseling may be performed virtually with visual aids and online resources • Genetic counselors may manage invasive testing and blood samples remotely • Carrier screening saliva kits may be sent to patients' homes
Mental health services	• Virtual visits may be conducted with acknowledgment that the experience is different than in-person encounters
Obstetric anesthesia	• Virtual visits may be performed with airway exam • Telehealth discussion focuses on eligibility for labor analgesia and timing • In-person evaluation occurs on inpatient admission with exam of airway and spine
Postpartum care	• Routine postpartum visits including post-cesarean may be performed virtually unless there are acute symptoms • Lactation consultations may be performed virtually • A home blood pressure cuff is a key resource for management

Abbreviation: IUGR, intrauterine growth restriction.