Tatian Pinheiro, a 32-year-old nurse, experienced a high-risk pregnancy in Iranduba, in the Manaus metropolitan area, with repeated bleeding and fear of losing her baby. The routine of emergency visits to the maternity ward changed when she started accompanying a project that brought together local teams and experts from the Amazonas capital.
The Telepnar project (High-risk prenatal remote monitoring in remote areas of Amazonas) is an initiative implemented by Ufam (Federal University of Amazonas) in collaboration with the Ministry of Health, created in 2022 to reduce maternal, fetal and neonatal mortality in remote areas.
The program connects primary care experts with experts from the Getulio Vargas University Hospital in Manaus through a digital platform that allows each case to be monitored and discussed remotely.
The project is also present in 61 of the 62 municipalities of Amazonas state (excluding Manaus, which already has its own structure) and seven Special Indigenous Health Districts (Dsei). A total of 2,418 pregnant women have been treated since October 2023, when the project, which was previously in the implementation phase, started serving patients. Of these, 1,304 are still under observation, and approximately 23 have resulted in miscarriage or fetal death.
“The proposal arose from the fact that Amazonas has one of the highest maternal mortality rates in the country. The aim is to provide specialized care to women living in inland areas, often indigenous and riverside, who live in difficult-to-reach areas,” explains obstetrician-gynecologist and project coordinator Ione Blum.
Before Telepenal, she says, most pregnant women didn’t have access to an obstetrician. “Each high-risk woman is now monitored by a specialist, and this makes a huge difference.”
How remote monitoring works
UBS (Basic Health Units) and DSEI posts include high-risk pregnant women on a platform that integrates SUS electronic health records. From there, Ufam experts will assess the case, guide the actions of local experts and, if necessary, direct transfer to a high-risk outpatient department at a university hospital.
According to Lorraine Santos, a family and community physician in Iranduba, the system has provided agility and clinical safety. “After the initial consultation and risk stratification, we put the patient on the platform. The obstetrician usually returns on the same day. This avoids unnecessary travel to the capital,” he said.
Conditions that classify a pregnant woman as high risk include a history of recurrent miscarriages or multiple C-sections, as well as diabetes, gestational hypertension, severe obesity, severe anemia, recurrent urinary tract infections, and infections such as hepatitis and HIV.
Although the city of Iranduba is close to the capital, it is a riverside community that takes many hours by boat or car to reach its headquarters. “The geography of the state poses huge challenges, and we don’t have enough experts in every hub, so this kind of technology is essential,” he added.
According to Carlem Cabus, Telepnar’s supervising nurse, the program has also eliminated waiting lists for high-risk prenatal care in the state. “Pregnant women are not forced to wait for an appointment. They are either seen in person or monitored on the platform,” he said.
In addition to ensuring specialized support, this initiative has reduced unnecessary travel to Manaus and avoided long and expensive journeys, especially in areas with river access.
Luana Ferraz, Health Secretary of Ilanduba City, emphasizes the importance of a platform that provides specialized medical care to pregnant riverside women. “Our teams are able to travel to the region and provide care with obstetricians in Manaus using the Internet of Decentralized Centers. This way, patients can receive specialized guidance without leaving the region,” he says.
Tatian was diagnosed with uterine prolapse (a condition in which the uterus drops into the vaginal canal, which can cause miscarriage or premature birth), but with remote support from her medical team, she managed to maintain a stable pregnancy.
“I lost a lot of blood. I was in the maternity ward every 15 days. After that, I received medical and psychological support and guidance. I managed to stay at home until the birth,” she reports. The baby was born healthy.
Adrian Nascimento, 29, a physical therapist, is also participating in the project. After two miscarriages, she is now six-and-a-half months pregnant and attends biweekly check-ups with a telepner.
“I have polycystic ovary syndrome and adenomyosis. Now I’m constantly monitoring and I’m confident that the baby will be fine,” he says.
Another aspect of the program is the training of local professionals. To date, 3,041 doctors, nurses and midwives have been trained in-person or remotely to identify and monitor high-risk pregnant women in villages and remote communities.
The public health project is supported by Umane, a civil society organization aimed at supporting initiatives aimed at improving health.
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