Dr Avi Tsur, OB/GYN and high-risk pregnancy expert, tells FemTech World how telemedicine could transform our traditional healthcare system.
The world’s first Women’s Health Innovation Centre, directed by Dr Avi Tsur, OB/GYN and high-risk pregnancy expert, was launched as a collaborative effort by ARC – Accelerate, Redesign, Collaborate – Centre for Digital Innovation, the Sheba Gynaecology and Maternity Centre, and Gertner Institute for Health Policy at Sheba Medical Centre in Israel.
Originally designed to promote patient and doctor safety during the pandemic, the centre combines telemedicine with in-person visits to “enhance treatment and offer patients the best care possible”.
“Sheba Medical Centre is the largest hospital in Israel and one of the leading hospitals in the world,” says Dr Avi Tsur, who serves both as director of the Women’s Health Innovation Centre and of OB/GYN BEYOND, the first virtual obstetrics and gynaecology department, as well as an attending physician at the Josef Buchmann Gynaecology and Maternity Centre at Sheba.
“The Women’s Health Innovation Centre essentially treats all aspects of innovation in women’s healthcare, AI, telemedicine, virtual reality, precision medicine and inventing medical devices and incubates new concepts in telemedicine.
“Once we develop a comprehensive clinical service it is handed over to OB/GYN BEYOND, that is capable of taking it in to the next level, both from a clinical point of view, but also in terms of marketing strategy and budgeting.”
The new hybrid clinic for women with high-risk pregnancy focuses in particular on transforming care for women with diabetes in pregnancy and offers both in-person and at-home visits that include comprehensive care, digital urine dipstick assessment, ongoing glucose monitoring, as well as foetal ultrasound and foetal monitoring.
“Following the Covid-19 outbreak, we started to use telemedicine technologies to treat women in hospital without having contact between the staff and the patients and that was a big step for us in being able to treat pregnant women remotely,” Dr Tsur tells me. “Now this hybrid approach means that multiple tests can be done at home, leveraging various technologies.”
Indeed, new analysis from McKinsey & Company has shown that telehealth utilisation has increased 38 times from pre-pandemic levels. “Telemedicine is very much like our chat right now,” explains Dr Tsur.
“Although our Zoom meeting is not as good as an in-person meeting, it allows us to do things that would not have been possible otherwise. Same goes for telemedicine services.
“When it comes to remote services, we also take into account the time it takes for a patient to get to the hospital, the time waiting for a nurse, an ultrasound and then, for a foetal monitoring assessment,” he continues. “In-person, all of these would take at least three hours, but when we switch to telemedicine visits, they take around 30 minutes.”
Even though telemedicine has certain limitations, Dr Tsur emphasises that there are many things that can be safely done at home. “I think around 90 per cent of things can be done remotely, especially within a hybrid system when we don’t miss the in-person meeting.
“Initially, many physicians and most of the patients were not aware of the possibility of doing an ultrasound or foetal monitoring assessment at home. But we arrange a first in-person visit, we take the patient to one of the rooms where we do telemedicine visits and we let them connect themselves to the foetal monitor so that they have the chance to see the monitor on the screen,” he explains.
“This way they can actually get the feeling of what we do and what we see in hospital. Once they do it, they feel more confident to do it at home next time.”
The Sheba Medical Centre, alongside the Israeli Foreign and Health Ministries, were also involved in establishing Shining Star, a dedicated field hospital in western Ukraine that served Ukrainian refugees and locals and trained local medical teams in telemedicine and field medical care.
The field hospital’s approximately 100-strong staff included doctors, nurses, medical lab workers, medical engineers, and pharmacists, as well as logistics and operational personnel. “We leveraged our technology to provide direct telemedicine services to refugees in Ukraine,” the high-risk pregnancy expert says.
“All of our physicians at Sheba, each one in his expertise, were interested in playing a role in the field hospital and with the telemedicine services, we were very eager to do everything we could to provide the best technologies care remotely.”
Dr Tsur believes that telemedicine can play an important role in humanitarian medicine. With hundreds of women at risk in Ukraine due to sexual violence, bad weather conditions and a lack of care, good pregnancy treatment is imperative.
The Israeli expert adds that: “Western medicine is very risk averse, which is not a bad thing, but I think we have to understand that humanitarian medicine creates different challenges, and being able to take some risks is needed if we seek to make a change.
“What we’ve been doing in Ukraine provided a great jump in expert-to-expert services, leveraging new technologies that allow experts in the field to consult even bigger experts in the hospital. It also taught us that we can’t reach the same ‘perfection’ often expected in the normal life scenarios.”
While the field hospital was limited to a certain amount of time, the use of telemedicine in various aspects of women’s health, during humanitarian crises, will continue.
“In many ways, our field hospital was limited in time because of the challenges we faced,” Dr Tsur points out. “Telemedicine, however, allows us to provide ongoing help to patients in remote places and it provides us with opportunities for learning more about humanitarian medicine. In my opinion, there’s a very good symbiosis between innovative inventive technologies and humanitarian medicine.”
The medical expert does not rule out other future projects and says that the team behind the Sheba Medical Centre is happy to collaborate and share their knowledge with other centres interested in doing similar things in various scenarios in countries taking refugees.
“My hope is that in five years from now, maternal foetal telemedicine will be maternal foetal medicine,” Dr Tsur adds. “I hope that pregnant women will receive the treatment that they need at home or at work or wherever they are. I also hope that we, at Sheba, will play an important role in developing the clinical paradigm and technologies serving this revolution, both in telemedicine and AI solutions.”
Would this mean less telemedicine hesitation? “I hope so. It’s our role to show people that telemedicine is safe. 10 years ago, people were hesitant to use mobile banking services, but we are in a totally different place today. I hope the same will happen with pregnancy services.”
For more info, visit eng.sheba.co.il.
FDA clears “innovative” maternal and foetal monitoring device
The device measures the electrical activity of the body and extracts maternal and foetal heart rate via cloud-based processing
The US FDA has granted clearance to a maternal and foetal monitoring device capable of measuring the electrical activity of the body.
The product, developed by the California-based maternal health company Bloomlife, is a prescription-based wearable device that aims to help healthcare providers measure maternal and foetal heart rate.
The device measures the electrical activity of the body and extracts maternal and foetal heart rate via cloud-based processing.
“Our pioneering consumer pregnancy tracker proved that women want access to more information during a pivotal time of her life,” said Eric Dy, co-founder and CEO of Bloomlife.
“The FDA clearance of Bloomlife MFM-Pro marks an important milestone by cementing our transition from consumer to medical markets.”
Earlier this year the WHO published its latest Trends in Maternal Mortality 2000 to 2020, which showed globally that in 2020 a woman died every two minutes due to pregnancy or childbirth complications. These trends are not limited to the developing world.
Before, during and after childbirth, women in the US are dying at a higher rate from pregnancy-related causes than in any other developed nation.
Increasing rates of high risk pregnancies demand greater clinical support, while decades long shortages of maternal health providers create barriers to care affecting urban and rural communities alike.
Bloomlife says it believes there is a role for technology to play in addressing this global maternal health crisis. The company aims to use technology to shift care from clinical settings to the home to deliver low-cost, “evidence-based” care.
“Covid revealed a significant amount of maternal care can be done outside of clinical settings. However, there remains a need to augment basic telehealth appointments with objective physiological data,” Dy explained.
“Utilisation of connected care solutions can not only increase the quality of virtual appointments, but allow us to build a more efficient, equitable and scalable means of screening and managing the health of mum and baby.”
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AI technology could detect pregnancy-related heart disease
A digital stethoscope has been shown to identify twice as many cases of peripartum cardiomyopathy as compared to regular care
An AI-enabled digital stethoscope could detect pregnancy-related heart disease, new research has shown.
The study, conducted by Mayo Clinic, has found that an AI-enabled digital stethoscope could improve the diagnosis of peripartum cardiomyopathy, a potentially life-threatening and treatable condition that weakens the heart muscle of women during pregnancy or in the months after giving birth.
Researchers used the AI-enabled digital stethoscope that captures electrocardiogram (EKG) data and heart sounds to identify twice as many cases of peripartum cardiomyopathy as compared to regular care.
“We demonstrated for the first time in an obstetric population that AI-guided screening using a digital stethoscope improved the diagnosis of this potentially life-threatening and treatable condition,” explained lead study author Demilade A. Adedinsewo, an assistant professor of medicine in the department of cardiovascular medicine at Mayo Clinic in Jacksonville, Florida.
“This research can change current clinical practice from one that is reactive and symptom-driven to a more proactive approach of identifying pregnancy-related cardiac dysfunction using a simple, low-cost and effective screening tool.
“Earlier diagnosis would facilitate prompt and appropriate management of cardiomyopathy and reduce associated disease and death.”
Peripartum cardiomyopathy is a type of heart failure that can affect women late in pregnancy or after pregnancy. The disease weakens the heart, resulting in a decrease in the amount of blood that is pumped from the heart to other parts of the body.
It is typically diagnosed towards the end of pregnancy or in the months following and may be difficult for health professionals to detect because many of the symptoms are similar to those seen with normal pregnancy, such as shortness of breath and swelling in the feet and legs, according to the American Heart Association.
The rate of peripartum cardiomyopathy is somewhat low in the US, affecting one in every 1,000 to 4,000 pregnancies. However, it is more prevalent in countries like Nigeria, which has the highest reported incidence of peripartum cardiomyopathy worldwide, with it impacting as many as one in 96 pregnancies.
As part of the study, researchers from Mayo Clinic looked at almost 1,200 Nigerian women who were pregnant or had recently had a baby.
Approximately half were evaluated with AI-guided screening using the digital stethoscope and half received usual obstetric care in addition to a clinical EKG. Peripartum cardiomyopathy was detected twice as often among study participants when EKG testing was performed with a digital stethoscope using an AI algorithm, compared to clinical EKG in addition to routine obstetric care.
Overall, four per cent of the pregnant and postpartum women in the intervention arm of the clinical trial had cardiomyopathy compared to two per cent in the control arm, suggesting that half are likely undetected with usual care.
“While we expected AI-guided screening to improve the diagnosis of cardiomyopathy, we did not anticipate the frequency of cardiomyopathy diagnosis would be doubled,” Adedinsewo said.
She added: “Additional large trials enrolling a diverse group of women in other geographic locations are needed to evaluate the impact of AI-guided screening on cardiomyopathy diagnosis as well as its impact on adverse maternal outcomes.”
From OB/GYN to entrepreneur: the Kenyan doctor rethinking maternal health
Maternal and newborn deaths are still a major public health problem in Kenya
Kenya has one of the highest maternal mortality rates in the world. In 2020, the maternal mortality ratio in the East African country was 530 deaths per 100,000 live births – much higher than the global average of 223 maternal deaths per 100,000 live births. The ratio of babies who die in the first month of life is also higher than the global average.
However, as Dr Lorraine Muluka, a Nairobi-based OB-GYN and founder of the health tech start-up Malaica, has found out, most of these deaths can be prevented if women have access to safe and affordable maternal health services.
Here, the consultant-turned-entrepreneur tells us why she thinks innovation will prove to be essential in bridging the health gaps in the Kenyan healthcare system.
Hi Lorraine, could you tell us a bit more about your background?
My name is Dr Lorraine Muluka and I am an OB-GYN. I am also the co-founder and CEO of Malaica, a health tech start-up that focuses on maternal health in Kenya. I hold a master’s degree in medicine in obstetrics and gynaecology from the University of Nairobi and have worked in various private and mission hospitals in Kenya’s maternal healthcare sector.
Over the past decade, I have been involved in several healthcare start-ups, driven by my passion for innovating and improving the Kenyan healthcare system. I have also been practising as a consultant obstetrician at my private practice in Nairobi. In 2021, I decided to fully commit to my vision of improving maternal health in Kenya by co-founding Malaica.
What inspired you to create Malaica?
The birth of Malaica was driven by a shared passion by the co-founders for safe motherhood and an aspiration to transform the narrative of maternal and neonatal mortality ratios in Sub-Saharan Africa.
Personally, as an OB-GYN several times it was very frustrating seeing mothers lose their lives to preventable causes. A need to fix the gaps and delays in maternal healthcare that lead to poor pregnancy outcomes is at the core of Malaica and the inspiration behind its creation.
The delays women experience begin with a woman’s decision to seek care, extend to her access to the appropriate healthcare facility and also the quality of care she receives once there. These gaps result from the various challenges women face which include limited access to quality care, lack of continuous support and high healthcare costs among others.
By recognising and addressing these gaps, Malaica aims to provide a holistic, affordable, and supportive environment for expectant mothers, ultimately improving maternal and neonatal health outcomes.
How would you describe Malaica in a few words?
Malaica provides a dedicated online support team for expectant mothers, making the journey of pregnancy happier, more affordable, and safer. With Malaica by their side, expectant mothers can rely on the invaluable companionship and guidance they need throughout their pregnancy.
What makes Malaica different?
Malaica offers a unique approach to pregnancy support that focuses on the holistic wellbeing of expectant mothers, including physical health, mental wellness, and delivery readiness. Our online platform offers personalised care for each woman at an affordable cost, with a personal nurse midwife assigned to provide support throughout pregnancy.
We provide access to obstetricians/gynaecologists, educational content, and a nurturing online community moderated by supamums for peer support. In Nairobi, we offer both virtual and in-person ANC clinics and birth preparation classes.
What sets us apart is our unwavering empathy, creating a warm and supportive environment for expectant mothers. Malaica adapts to evolving needs, making us the ideal choice for pregnancy support.
Women’s health comes with a lot of stigma. How has this impacted you as a founder?
In all my years of practising medicine, especially in obstetrics and gynaecology, I have noticed that there is a lot of stigma surrounding women’s health, especially during pregnancy. This stigma can take many forms, from societal taboos to misunderstandings about women’s health issues. Sometimes, it’s challenging to remove these barriers and create an open and supportive environment where soon-to-be mothers can access the care and assistance they need.
However, this awareness of the problem has become a powerful motivation for me. It has encouraged me to work even harder to break down these obstacles and create a safe space where women can receive the care and support, they require without being judged. It has reinforced Malaica’s commitment to empathy and understanding, ensuring that we remain a platform that is free from stigma, where mothers-to-be can access the care and guidance they need with dignity and respect.
What obstacles have you encountered on this journey?
As pioneers in the industry, we face a unique set of challenges as a remote company. One of our main challenges is proving to potential clients that our services are genuine and essential. We also strive to provide high-quality care while managing costs, which can be difficult for affordable programs like Malaica’s.
Providing physical services in remote or underserved areas poses a logistical challenge, especially considering the competitiveness of the healthcare and pregnancy support industry. Many other providers are offering similar services, so we must work hard to stand out.
As a tech company, we require ongoing technological investments and cybersecurity measures to maintain a reliable online platform for our subscription program and telehealth services.
Another challenge we face is health education. Educating expectant mothers about the importance of maternal health and the services available to them can be difficult, particularly in areas with limited health literacy.
Finally, ensuring the financial sustainability of the business, especially when offering affordable subscription programs, can be quite challenging. However, social enterprises like Malaica play a vital role in improving maternal health and supporting expectant mothers. Our dedication to our mission can lead to positive outcomes for both the business and the community it serves.
What lessons have you learned?
My journey as the founder of Malaica has taught me several vital lessons. I’ve come to understand that empathy is the cornerstone of effective support for mums-to-be. Recognising the diversity of experiences among our users and tailoring our services accordingly is crucial.
Building a strong community of support through supamums and support groups is powerful. The world of women’s health is ever-evolving, necessitating continuous adaptation and improvement.
Challenging the stigma surrounding women’s health is essential, and affordability should never be compromised. Collaboration with experts enhances the quality of care, and unwavering passion fuels dedication to our mission. These lessons guide our commitment to making pregnancy safe, convenient, and stigma-free for women worldwide.
Where are you with Malaica now?
Malaica has come a long way since its inception. We are now a reliable and easily accessible online platform for pregnancy support services, with a reach across the nation. Our commitment to providing comprehensive care, including access to nurse midwives, specialists like gynaecologists, paediatricians, psychologists, and support groups, has cemented our position as a go-to resource for expecting mothers. We strive to eliminate the stigma surrounding women’s health and continue to evolve and grow.
Malaica’s commitment to affordability and inclusivity ensures that we remain a beacon of support for women worldwide. Although our journey is ongoing, we are proud of the progress we have made.
Where do you see the company in the future?
We are committed to expanding Malaica’s reach and improving the pregnancy journey for expectant mothers in Kenya and beyond. Our ultimate goal is to ensure that even more mothers have access to better support and care throughout their pregnancy.
As a health tech company, we will continue to leverage advanced technology for telehealth services, making our services more accessible and convenient, especially for mothers in remote areas.
We also aim to foster connections among mothers and provide a strong network of emotional support through our expanding community of expectant mothers. Additionally, we are building partnerships with healthcare institutions, NGOs, and government bodies to strengthen our impact on maternal health and reach underserved populations.
Education and advocacy are major challenges in the pregnancy healthcare space, and we will continue to engage in initiatives that raise awareness about maternal health issues and promote healthy pregnancy practices.
Overall, we are optimistic about Malaica’s future as we adapt to the changing healthcare landscape and provide essential support to expectant mothers.
Dr Lorraine Muluka holds a master’s degree in medicine with a specialisation in obstetrics and gynaecology. Driven by a passion for improving the Kenyan healthcare system through innovation, Dr Muluka has played significant roles in several healthcare start-ups over the past decade, while also maintaining her role as a consultant obstetrician at her private practice in Nairobi. At the end of 2021, Muluka co-founded the health tech start-up Malaica. She is currently serving as the CEO of the company.
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