Summary of existing evidence.

BackgroundUltrasound is a common diagnostic modality in obstetrics to evaluate the fetal condition, frequently used in pregnant women classifying as high-risk. Modifications to guidelines, implementation of national initiatives, combined with an aging obstetric population has led to an increased number of high-risk patients. This places a substantial strain on outpatient obstetric services to accommodate the increased demand for serial antenatal ultrasound scans.Recent advancements in digital technology have enabled the swift innovation of teleultrasound development. The recent pandemic has also substantially influenced technological development, as obstetric services considered alternative solutions to healthcare provision standards. This review aims to assess whether teleultrasound is feasible, acceptable, diagnostically accurate, and cost-effective for antenatal care.Methods and findingsWe searched MEDLINE, Embase, Cochrane Database of Clinical Trials (CENTRAL), Web of Science, and PubMed databases from inception to December 2025. Primary research studies evaluating the feasibility, diagnostic accuracy, clinical utility, educational utility, acceptability, and economic viability of antenatal teleultrasound usage were included. Random effects meta-analysis was used, and results were reported as pooled proportions or risk ratio (RR) with 95% confidence interval (CI). Diagnostic accuracy was further assessed using a hierarchical summary receiver operating characteristic model.Of the 6,561 papers screened, 71 studies (60 clinical observational studies, five qualitative studies, four economic evaluation studies, and two randomized controlled trials) were included. Image transfer was feasible for both synchronous and asynchronous teleultrasound transmission, in a wide range of settings. Adequate technological infrastructure, including appropriate bandwidth and framerate requirements were vital factors for sufficient image quality and minimizing transmission delays. Visualizing gross fetal and placental structures using teleultrasound was frequently high; however, more specialized anatomy such as cardiac and neurological demonstrated lower visualization rates. Overall meta-analysis of 20 anatomical structures demonstrated teleultrasound is non-inferior at identification versus the reference standard RR 1.02 (95% CI [1.00,1.03]; n = 4 studies). Pooled diagnostic accuracy demonstrated excellent performance, with an AUC of 0.93 (n = 8 studies). The overall sensitivity was moderate at 0.70 (95% CI [0.44,0.84]), with a low false positive rate of 0.03 (95% CI [0.01,0.12]). There was evidence of educational and clinical utility for obstetric teleultrasound, particularly with novice users, demonstrating improved access to care in rural areas and low- and middle-income countries. Patient-operated telesonography demonstrated feasibility and high acceptability for performing basic fetal assessments. Three-dimensional, four-dimensional, and robotic teleultrasound did not highlight superiority to two-dimensional scanning. Patients and provider acceptability was high, citing benefits in relation to satisfaction, confidence, economic savings, and balancing healthcare equity. Teleultrasound implementation costs can be high, but were frequently accrued due to monthly savings. High-quality studies were underrepresented, suggesting a need for further research. The reporting of clear methodological and technological capabilities of the teleultrasound systems represent the main limitations, proving difficulty to replicate studies adequately.ConclusionThis review demonstrated the potential applicability and value of obstetric teleultrasound. This novel care model is everchanging and new devices/systems capable of telesonography are of clinical and scientific relevance. Presently, additional high-quality evidence is required, particularly using teleultrasound in a clinical context, whilst ensuring sufficient methodological detail and consistent outcome reporting.