Summary of studies using robotic teleultrasound.

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.背景 超声（Ultrasound）是产科领域评估胎儿状况的常用诊断手段，常应用于妊娠高危人群的筛查。指南修订、国家相关举措的推行，加之产科接诊人群年龄增长，使得高危妊娠患者数量持续攀升，这给门诊产科服务带来了巨大压力，以应对日益增长的系列产前超声扫描需求。 近年来数字技术的进步推动了远程超声（teleultrasound）领域的快速发展。近期的全球大流行也极大推动了相关技术的迭代升级，因产科医疗服务亟需寻求符合医疗服务标准的替代方案。本综述旨在评估远程超声应用于产前护理的可行性、可接受性、诊断准确性与成本效益。 方法与结果 本研究检索了自建库至2025年12月的MEDLINE、Embase、考克兰临床对照试验数据库（Cochrane Database of Clinical Trials, CENTRAL）、Web of Science及PubMed数据库。纳入所有评估远程超声产前应用的可行性、诊断准确性、临床效用、教学效用、可接受性及经济可行性的原创研究。采用随机效应模型进行Meta分析，结果以合并比例或风险比（risk ratio, RR）结合95%置信区间（confidence interval, CI）进行报告。诊断准确性进一步通过分层汇总受试者工作特征（hierarchical summary receiver operating characteristic）模型进行评估。 在初筛的6561篇文献中，最终纳入71项研究（其中60项为临床观察性研究、5项为质性研究、4项为经济评价研究、2项为随机对照试验）。在多种临床场景下，同步与异步远程超声的图像传输均具备可行性。充足的技术基础设施——包括适配的带宽与帧率要求——是保障图像质量、降低传输延迟的关键因素。通过远程超声可清晰识别大部分胎儿与胎盘结构，但对于心脏、神经系统等复杂解剖结构的可视化率相对较低。针对20种解剖结构的整体Meta分析显示，远程超声在结构识别方面不劣于参考标准，风险比RR为1.02（95%CI [1.00,1.03]；n=4项研究）。合并后的诊断准确性表现优异，曲线下面积（area under the curve, AUC）为0.93（n=8项研究）。整体灵敏度中等，为0.70（95%CI [0.44,0.84]），假阳性率较低，为0.03（95%CI [0.01,0.12]）。研究证实产科远程超声具备教学与临床应用价值，尤其针对新手使用者，可改善农村地区及中低收入国家的医疗可及性。患者自主超声检查（patient-operated telesonography）的可行性与可接受度均较高，可用于完成基础胎儿评估。三维、四维及机器人远程超声并未展现出优于二维扫描的性能。患者与医护人员的接受度均较高，认可其在提升诊疗满意度、增强诊疗信心、节约医疗成本及促进医疗公平方面的优势。远程超声的部署成本可能较高，但通常可通过月度成本节约抵消。高质量研究的占比偏低，提示仍需开展更多相关研究。现有研究对远程超声系统的方法学与技术参数报告不够清晰，这是主要局限，导致相关研究难以被充分复刻。 结论 本综述证实了产科远程超声具备潜在应用价值与临床意义。这一新型护理模式仍在持续迭代，具备远程超声功能的新型设备与系统具有重要的临床与科研价值。目前仍需更多高质量证据支持，尤其需开展临床场景下的远程超声研究，并确保研究方法学细节充足、结局报告标准统一。