ROC-a-Bye Baby

When Frederique Migliaccio of Queens, N.Y., went into labor in the 20th week of her pregnancy earlier this year, her obstetrician--John P. Brennan of Long Island College Hospital--was able to suggest an innovative precaution: the remote obstetrical care box, or ROC box.

Brennan had developed the PC-based system as a way to conduct prenatal care remotely over telephone lines. It’s a member of an emerging family of “telemedicine” systems that many heath professionals believe will have a major impact on health care.

Migliaccio later phoned Brennan at the end of her pregnancy to report that she wasn’t feeling the baby move much. “Usually, I would have had her come into the hospital. But seeing that we had all that equipment there at her house, I suggested that she hook herself up to the fetal heart monitor to let me have a look at the baby’s vital signs and see if he was in any distress,” recalls Brennan.

“When I looked at the tracings, I saw a lot of decelerations of the fetal heartbeat. The normal fetal heart rate is about 140 beats per minute. Here, Frederique was having some small uterine contractions, and each time she had a contraction, the fetal heart rate would slow down to 100 beats per minute. Something was clearly wrong with the baby,” says Brennan.

He instructed his patient to meet him immediately at the hospital, and Brennan’s remote assessment of the baby’s condition was confirmed by in-hospital monitoring. He ordered an immediate caesarean section and found that the baby’s umbilical cord was coiled around her neck.

“My baby is alive because I had this machine at home. I don’t know what would have happened if I had to go the hospital first to check my condition,” says Migliaccio.

The ROC box is centered around a Pentium-based portable computer with special videoconferencing accessories, and to tap all its capabilities requires a high-speed communications link. Brennan uses ISDN (integrated service digital network) lines provided by local telephone companies.

The ROC box also includes peripherals to measure fetal heart rate, maternal blood pressure and weight, urine dipstick results and uterine growth and contractions. The unit includes a medical information management system to keep track of test results. The system automatically graphs trends in weight gain, blood pressure and uterine growth. Measurements that fall outside the range of normal are flagged.

While it has already become commonplace for doctors to send simple images, including X-rays, over phone lines, Brennan says the breadth of his systems’ capabilities make it unique. Brennan demonstrated the ROC box’s teleconferencing capability in January at the Medicine Meets Virtual Reality 5, or MMVR5, conference held in San Diego. In a live, multi-point telemedical session, Brennan conducted a prenatal visit in real time with a pregnant patient--Frederique Migliaccio--3,000 miles away.

Migliaccio underwent electronic fetal monitoring, maternal physiological testing and an ultrasound exam. Brennan consulted with a Baltimore obstetrician at the same time he conducted a teleconference with Migliaccio.

Brennan has formed a company to further develop the device and seek FDA approval; he believes it has broad applications--especially in medically underserved rural areas. Even in areas with an adequate number of physicians, says Brennan, traveling to a doctor’s office or clinic in late pregnancy can prove problematic or uncomfortable for women, especially if they have other children.

The full-blown system, including a $15,000 ultrasound machine, costs about $25,000, so it isn’t likely that a lot of pregnant women will have one in their home. But clinics or doctors’ offices that otherwise lacked advanced prenatal-care systems might be able to install one to serve a community.

*

Mary Purpura and Paolo Pontoniere can be reached via e-mail at PMPurP[email protected]