




































Berkeley
Pharma Tech
Journal of Medicine

Correspondence: 
wojtaram@umich.edu

Keywords:
Telemedicine
Telehealth
Google trends
Obstetrics and gynecology   
Surgical telehealth

Submitted: April 14, 2023 
Accepted: July 24, 2023
Published: December 30, 2023

Full Open Access

Creative Commons Attribution 
License 4.0

Abstract
The coronavirus (COVID-19) pandemic resulted in a plethora of healthcare 
challenges. To adapt, many health systems implemented telehealth interventions. This 
retrospective study using data from March 1, 2021 to March 31, 2022 evaluates the 
relationship between the daily reported number of new COVID-19 cases and 
corresponding changes to search volume on obstetrics and gynecology telehealth visits. 
Google Trends™ outputs were compared to COVID-19 case data for the time period 
and region as provided by the World Health Organization (WHO). Spearman’s 
correlation coefficient (ρ) was used to determine the strength of the relationship 
between new cases and relative search volumes (RSVs) related to obstetrics and 
gynecology telehealth. Globally, there was a significant positive strong correlation 
between public interest regarding telehealth in obstetrics and gynecology and new 
COVID-19 cases (ρ=0.986, p-value<0.001). However, the United States and Mexico 
demonstrated non-significant poor correlations. Brazil exhibited a positive fair 
correlation. Based on this retrospective study, there was a steady rise in public interest 
in telehealth usage for obstetrics and gynecology throughout the pandemic. Increased 
telehealth intervention in the field of obstetrics and gynecology (ob-gyn) has shown 
promising initial results. There are numerous considerations for utilizing telehealth 
for surgical specialties such as ob-gyn. 

Interest in Telehealth for 
Obstetrics and Gynecology 
During the COVID-19 Pandemic
By: Magda Wojtara, Simran Athwal, Kehinde Dorcas Anuoluwapo 
Adebogun, and Maira Elahi



Berkeley Pharma Tech Journal of Medicine | 13 

1. Introduction

The COVID-19 pandemic had a large impact on the healthcare system globally. It 
prompted a shift to utilizing digital health solutions such as through telehealth 
or telemedicine. While some specialties were utilizing telehealth interventions prior 
to the pandemic, others, especially surgical specialties, had less uptake until the 
onset of the pandemic.1 A recent systematic review found that telehealth 
interventions not only improved obstetric outcomes, but also decreased the 
need for high-risk obstetric monitoring office visits.2 Considerations for 
surgical specialties include better patient preparedness for surgery with 
preoperative telehealth calls.3 Healthcare providers are refocusing and adopting 
information and communication technologies (ICTs) such as telemedicine as a 
benefit tool for real-time, online consultations.4 There has been a significant 
reduction in the prevalence of COVID-19 in North, Central, and South 
America because of the success in addressing vaccine hesitancy and vaccine 
uptake.5 Telehealth systems played a crucial role in decreasing the spread and 
number of COVID-19 cases. Telemedical alternatives ensured the safety of the 
healthcare workers by allowing them to maintain the continuity of care to 
patients remotely.6 It limited the spread of the pandemic by offering virtual visits 
from the comfort of a patient’s home, allowing symptomatic patients to receive 
expert medical advice, and reducing the number of visitors to hospitals. 

Telemedicine usage increased during the COVID-19 pandemic as the pandemic 
also triggered patient demand for virtual healthcare services.6 Telemedicine 
incorporates the use of sound and video technology to allow for remote patient 
health visits, which were more sought out during the pandemic.6 Even though 
telehealth cannot replace in–person visits, especially surgical procedures which 
cannot be performed remotely, it does lessen risks of unnecessary exposure and 
offers a secure way of providing testing and services. Telehealth interventions 
were notably effective in reducing the burden of healthcare systems during the 
pandemic.7 While telehealth has been utilized in primary care and some specialties, 
telehealth uptake has not been as prevalent amongst surgical specialties. 
Telehealth usage for surgical specialties remains higher than pre-pandemic levels. 
It is important to consider this emerging dimension of healthcare delivery and 
the rapid adoption of new technologies in obstetrics and gynecology.  A 
recent study found that maternal-fetal medicine obstetrical patients and 
providers were satisfied with telemedicine because it improved access to 
healthcare providers, saved time on traveling, and provided safety from any 
physical contact during the time of the COVID-19 pandemic.8 For prenatal care, 
telehealth virtual visits consolidated the in-person visits for prenatal 



Berkeley Pharma Tech Journal of Medicine | 14 

screening and surveillance, alongside minimizing COVID-19 exposure and patient 
travel.9 

Google Trends™ is a dynamic tool that offers insights into the popularity of search 
terms and topics on the world's most widely used search engine, based on data from 
billions of searches that Google processes every day. Its ability to display relative 
search volumes for a given keyword compared to the total search volume on Google 
over a specific period and location is one of its key features.10 The timing of searches 
on Google Trends™ can be highly correlated to events such as a spike in cases of a 
particular disease or health condition, as individuals often rely on the internet for 
information about their health.11 During the outbreak of COVID-19, there was a 
surge in searches for symptoms, testing, and treatment options, and the global 
Google Trends™ index peaked on March 12, 2020 when COVID-19 was 
proclaimed a pandemic. As such, it was shown that RSV indices can be used to track 
the spread of an outbreak like the present COVID-19 pandemic.12 A population-
based study demonstrated a strong correlation between search interests in ‘COVID-
19’, ‘COVID pneumonia’, and ‘COVID heart’, and the COVID-19 daily new cases 
and new deaths. This study provided evidence that the trends in COVID-19 daily 
new cases and new deaths in the USA are substantially connected with search-
interests relevant to COVID-19.13 In another study, the strongest correlations were 
observed between ‘face mask’, ‘Lysol’, and ‘COVID stimulus check’ among the 10 
keywords analyzed from Google Trends™ when looking at the United States as a 
whole, with R values of 0.88, 0.82, and 0.79, respectively.14 

Google Trends™ is a research tool that provides information on the frequency at 
which specific search terms are entered into Google relative to the total search 
volume regionally or globally. This tool allows for data collection to provide insight 
into the trends related to the public interest in different healthcare subjects using 
keywords.15 The output of Google Trends™, relative search volume (RSV), reflects 
changes in the magnitude of online public interest in a particular subject.16 This 
association between RSV and public interest permits the primary objective of this 
study, which is to examine the association between the daily reported number of 
new cases during the COVID-19 pandemic and corresponding changes in RSV of 
topics in obstetrics and gynecology telehealth in selected North, Central and South 
American countries on March 1, 2020 - March 31, 2022. Countries were selected 
based on data availability. 

2. Materials and Methods 

2.1 Study Tool 



Berkeley Pharma Tech Journal of Medicine | 15 

Google Trends™ is a tool to analyze the public’s interest via analyzing the number 
of web searches for a given term. Google is the most utilized search engine; therefore, 
the prevalence of web searches on Google represents public interest in a topic. 
Google Trends™ allows any user to extract data from a selected time period and 
selected region or country. These searches can be further localized and are indicated 
in order of prevalence by country and city. The selection of appropriate keywords 
for utilization in Google Trends™ is crucial for obtaining an accurate idea of public 
interest in a topic. The “+” feature allows users to search multiple related or 
synonymous keyword terms. This allows users to create a combination of keywords 
that accounts for different possible searches on the same topic. 

The output of a Google Trends™ search is displayed as relative search volume 
(RSV), which expresses the search volume that corresponds to the number of 
searches for a given keyword. It is displayed on a numerical scale in a visual and 
downloadable data file form from 0 to 100,  where 100 is the peak of the search term 
for the selected duration and geographic location whereas 0 indicates an almost 
negligible amount of searches for the term given those parameters.17 Google 
Trends™ is a good approximation of searches and public interest; however, it does 
filter out some types of searches. These types of searches include: (1) searches made 
by very few people appear as “0” (2) duplicate searches from the same person in a 
short period of time are eliminated (3) queries with apostrophes and other special 
characters are filtered out from the trends.17 

2.2 Study Design 

This was a retrospective study conducted to determine the relationship between the 
new COVID-19 cases and the public interest towards obstetrics and gynecology 
telehealth. To get a longitudinal analysis, a time range was selected for the study 
from March 1, 2020 to March 31, 2022. Peaks in hospitalizations vary by country 
and region, so this study included a larger time range to provide better insight into 
any relationship between COVID-19 cases and public interest towards obstetrics 
and gynecology telehealth. 

3. Selection Criteria 

The World Health Organization operates a COVID-19 tracker which allows 
for surveillance of global COVID-19 data since the start of the pandemic. This 
tracker reports the official count of total confirmed cases and the number of new 
cases in each country. It is important to note that testing for COVID-19 
has been 



Berkeley Pharma Tech Journal of Medicine | 16 

challenging in many countries with the strain on already struggling healthcare 
infrastructures. Additionally, the number of tests performed has dropped as cases 
have declined and the vaccine uptake has increased. As a result, there may be 
discrepancies between the reported number of confirmed cases at a specific time. 
We chose to determine the relationship between RSV from Google Trends™ and 
the number of new cases reported per day. 

3.1 New COVID-19 Cases 

Countries with the highest number of total confirmed cases of COVID-19 in 
North, Central and South America as of March 1, 2023 were selected to be part of 
the study. Based on this criterion, the following countries were included: United 
States of America, Mexico, and Brazil. The data for these countries and the 
worldwide data for new cases were extracted from reports published on the WHO 
website from March 1, 2020 to March 31, 2022.18 

3.2 RSV Data from Google Trends™ 

The initial combination of keywords selected for our study was “ob-gyn telehealth”, 
“telemedicina obstetricia y ginecológica”, and “telemedicina obstetrícia e 
ginecologia” to reflect English, Spanish and Portuguese searches. These keywords 
were used with the “+” feature of Google Trends™. These keywords were selected 
on the basis that they are most utilized by the public and interchangeable with other 
variants that differ in the ordering of the terms. The data for these search terms were 
downloaded from the Google Trends™ website. The following filters were selected 
before extracting the data: “3/1/2020 to 3/31/2022” as time range; “all categories” 
for the category, and “web search” for the type of search. The parameter “region” 
was changed to either the United States, Mexico or Brazil respectively to obtain data 
for each country. The worldwide RSV for these parameters was downloaded from 
the site in order to compare public interest in obstetric and gynecology telehealth 
globally during the pandemic. 

3.3 Statistical Analysis 

The data extracted from the World Health Organization and Google Trends™ 
were entered and analyzed using the Statistical Package for Social Sciences (SPSS) 
version 29.0 (IBM Corp., Armonk, NY). The RSV data for each country for the 
search terms from 3/1/2020 to 3/31/2022 were plotted against the number of new 
COVID-19 cases reported for that country. The data were visually plotted as a 
histogram using the feature of the bell-shaped curve, and then tested by the Shapiro-



Berkeley Pharma Tech Journal of Medicine | 17 

Wilk test. Given that the data was aberrantly distributed, Spearman’s rank-order 
correlation test was performed to analyze the association between the RSV and 
number of new COVID-19 cases worldwide and in each of the selected countries. 
The Spearman’s correlation coefficient which is denoted by ‘ρ’ was used to 
determine the strength and direction of the relationship between two variables. This 
coefficient’s value lies between -1 to +1 with a “-” sign indicating an inverse 
relationship, a “+” sign indicating a positive correlation, and “0” demonstrating no 
correlation between the variables [19]. A “-1” value indicates a perfect negative

association whereas a “+1” value indicates a perfect association. The value of 

ρ ≥ 0.8 was used to depict a very strong relation, ρ < 0.8 and ≥ 0.6 for 

moderately strong relation, ρ < 0.6 and ≥ 0.3 for fair relation, and ρ < 0.3 for a 

poor relation between the variables  [19].  A p-value of < 0.05 was considered 
statistically significant for this study. 

4. Results

4.1 Relative Search Volume Data 

4.1.1  Worldwide 

The global interest regarding telehealth in obstetrics and gynecology was assessed 
during March 1, 2020 to March 1, 2022. As shown in Table 1, a mean of the global 
search volume regarding this type of telehealth was calculated to be 13.23 ± 22.34 . 
Based on the study’s selection criteria, countries from North, Central and South 
America were selected due to their high amount of total COVID-19 cases: the 
United States, Mexico, and Brazil. 

Table 1. Means of Google Trends RSVs related to obgyn telehealth during the 
COVID-19 pandemic 

Country/Region Mean Standard Deviation 

Worldwide 13.23 22.34 

United States 21.89 14.58 

Mexico 0* 0* 

Brazil 0** 0** 

https://pubmed.ncbi.nlm.nih.gov/14770254/
https://pubmed.ncbi.nlm.nih.gov/14770254/


Berkeley Pharma Tech Journal of Medicine | 18 

* Searches in Spanish for ob-gyn telehealth yielded no significant Google trend 
results
** Searches in Portuguese for ob-gyn telehealth yielded no significant Google trend 
results

The selected time range was March 1, 2020 to March 31, 2022. During January 
2022, it was observed that new COVID-19 cases rose sharply. One of the highest 
number of cases was the week of January 10th- January 17th, 2021 when the total 
number of confirmed cases rose 4,583,915 to a total of  23,309,763. Another 
notable peak was the week of December 19-December 26, 2022 when cases rose 
29,381,144 to a total of 44,265,843 confirmed cases. The maximum RSV 
(RSV=100 for our search terms was recorded on January 17, 2021. Interestingly, 
the RSV slope illustrated a no discernable trend after January 17, 2021. It would 
peak several times including July 18, 2021  (RSV=90 and January 16, 2022 
(RSV=74. A period from September-November 2021 showed a minimum RSV of 
0. 

4.1.2  United States of America 

In March 2020, the mean RSV for “ob-gyn telehealth” was calculated to be 17.60 ± 
17.59. In March 2021, the mean RSV was calculated to be 18.00 ± 22.33. In March 
2022, the mean RSV was calculated to be 0 ± 0. 

Interest in telehealth for obstetrics and gynecology during the COVID-19 pandemic 
was also plotted against new cases reported worldwide per day. This was illustrated 
for March 1, 2020-February, 2023 in Figure 1. 



Berkeley Pharma Tech Journal of Medicine | 19 

4.1.3  Mexico 

Due to a lack of any Google Trends results for ob-gyn telehealth in English or 
Spanish, we instead monitored the RSV of the terms “telemedicina” and 
“obstetricia” separately. In March 2020, the mean RSV for “telemedicina” was 
calculated to be 5.60 ± 2.19. In March 2021, the mean RSV was calculated to be 
3.00 ± 2.16. In March 2022, the mean RSV was calculated to be 6.75 ± 2.75. 

In March 2020, the mean RSV for “obstetricia” was calculated to be 56.40  ± 12.62. 
In March 2021, the mean RSV was calculated to be 58.00 ± 5.29. In March 2022, 
the mean RSV was calculated to be 80.75 ± 9.21. 

4.1.4  Brazil 

Due to a lack of any Google Trends™ results for ob-gyn telehealth in English or 
Portuguese, we instead monitored the RSV of the terms “telemedicina” and 
“obstetricia” separately.  In March 2020, the mean RSV for “telemedicina” was 
calculated to be 42.00 ± 31.34. In March 2021, the mean RSV was calculated to be 
47.00 ± 6.78. In March 2022, the mean RSV was calculated to be 26.75 ± 2.99. 

Figure 1.



Berkeley Pharma Tech Journal of Medicine | 20 

In March 2020, the mean RSV for “obstetricia” was calculated to be 21.50  ± 6.95. 
In March 2021, the mean RSV was calculated to be 17.25 ± 1.50. In March 2022, 
the mean RSV was calculated to be 24.25 ± 0.50. 

4.2 Spearman’s Correlation Analysis Between Google Trends™ and 
New COVID-19 Cases 

The Spearman’s correlation coefficient which is denoted by ‘ρ’ was used to 
determine the strength and direction of the relationship between RSV and new 
COVID-19 cases during the selected time frame. This coefficient’s value lies 
between -1 to +1 with a “-” sign indicating an inverse relationship, a “+” sign 
indicating a positive correlation, and “0” demonstrating no correlation between the 
variables.19 A “-1” value indicates a perfect negative association whereas a “+1” 

value indicates a perfect association. The value of ρ ≥ 0.8 was used to depict a 

very strong relation, ρ < 0.8 and ≥ 0.6 for moderately strong relation, ρ < 0.6 

and ≥ 0.3 for fair relation, and ρ < 0.3 for a poor relation between the 

variables.19 A p-value of < 0.05 was considered statistically significant for this 
study. 

Table 2. Spearman’s Correlation of RSVs and new COVID-19 cases 

Region/Country Spearman’s correlation 
coefficient (ρ) 

P-Value

Worldwide 0.986e <0.001a

United States 0.181c 0.533 

Mexico* “Telemedicina”: -0.231b 0.426 

“Obstetrica”: -0.227b 0.435 

Brazil* “Telemedicina”: 0.330d 0.249 

“Obstetrica”: -0.205b 0.482 



Berkeley Pharma Tech Journal of Medicine | 21 

*Mexico and Brazil Spearman’s Correlation was performed between “telemedicina” 
and “obstetrica” RSV separately with new COVID-19 cases
a indicates p-value < 0.05 which was considered statistically significant; b indicates 
negative poor correlation; c indicates positive poor correlation ;  d indicates positive 
fair correlation  e indicates a positive strong correlation

Based on these standards and the calculated Spearman’s correlation coefficient, a 
few interesting findings emerged. Worldwide there was a significant positive strong 
correlation between RSV for “obgyn telehealth” and new COVID-19 cases March 
1, 2020-March 31,2022. In the United States, there was a non-significant positive 
poor correlation between RSV and new cases for the same keyword and timeframe. 
In Mexico, there were non-significant negative poor correlations between RSV for 
“telemedicina” or “obstetrica” and new COVID-19 cases March 1, 2020- March 31, 
2022. In Brazil, there was a non-significant negative poor correlation between RSV 
for “obstetrica” and new COVID-19 cases whereas there was a non-significant 
positive fair correlation between RSV for “telemedicina” and new COVID-19 cases 
March 1, 2020- March 31, 2022. 

5. Discussion 

As our previous findings have indicated, telehealth interventions have brought forth 
advantages during the COVID-19 pandemic that shifted the viewpoint on 
telehealth as the prominent care delivery mode. However, there were certain barriers 
for telehealth uptake for surgical specialties. Not all health care providers are 
interested in utilizing telehealth interventions or are equipped with the 
technological infrastructure to do so.20  During the COVID-19 pandemic, there was 
a rise in the utilization of telehealth in various countries due to the multiple 
advantages it provided compared to in-person visits.21 With the help of telehealth 
care, patients could still consult with doctors even during self-quarantine; patients 
with either suspected or confirmed symptoms could be closely telemonitored using 
a telehealth cloud-based form, allowing for the maintenance of minimal patient and 
care-provider exposure.22 Additionally, physicians quarantined due to exposure to 
COVID-19 could still deliver healthcare services to non-exposed patients using tele-
intake and care for patients remotely.23 Furthermore, implementing telemedicine 
during the pandemic decreased the likelihood of the further spread of COVID-19 
through remote care of patients; it also reduced the rate of emergency room visits.24 
Several categories of patients benefited from telehealth during the COVID-19 
pandemic, including elderly patients and patients with chronic conditions such as 
diabetes mellitus and hypertension.25 For example, a cross-sectional study 
conducted in Ontario before and during the pandemic found a significant increase 



 

Berkeley Pharma Tech Journal of Medicine | 22 

in telemedicine visits in patients with chronic disease conditions and patients of 
older age groups in rural areas during the pandemic.25 Telemedicine would be 
particularly helpful to these groups of people, especially in rural regions, due to a 
decrease in the cost of traveling and time spent traveling. Other benefits include 
reduced hospital readmission and increased availability of inpatient beds for patients 
requiring critical care.25 Several measures were put in place to facilitate the 
integration of telehealth care during the pandemic; for example, due to the 
increasing patient load during the pandemic, several countries expanded access to 
telehealth using various methods such as relaxing previously strict laws regarding 
telehealth, which had been put in place due to ethical concerns, concerns about 
patient data privacy, and concerns about accountability.21 Similarly, the lack of 
insurance coverage for telehealth is another factor that initially limited the 
incorporation of telehealth into healthcare systems before the pandemic; however, 
insurance companies have begun reimbursing patients' costs incurred due to 
telehealth care delivery.21 

 
It is evident that COVID-19 has caused a global crisis. This subsequently resulted 
in a paradigm shift within the healthcare and public health systems, the loss of 
millions of lives, and economic disruption. Healthcare systems across the world 
developed a new framework encompassing public health functions such as testing, 
contract tracing, disease surveillance, telehealth, and non-pharmaceutical public 
health interventions.26 Despite differences in healthcare infrastructure across North, 
Central and South America, these regions all actively considered telehealth to meet 
the increased health needs of their populations. In North America, there is a focus 
on providing the public with a mix of public and private programs. In the United 
States, there is Medicaid, a public program, offered for those who fall within the 
category of being low-income and Medicare is a public program for older patients, 
and some younger individuals with disabilities. Within the United States, however, 
private insurance costs are often exorbitant. Canada, on the other hand, has a 
decentralized, universal and publicly funded health system called Canadian 
Medicare.27 Private insurance is held by ⅔ of Canadians and covers services excluded 
under universal health coverage such as vision and dental care, rehabilitation services 
and outpatient prescription drugs.27  Mexico also has both public and private 
healthcare sectors. The private sector has increased in prevalence over time, 
however, only 7% of Mexicans have private insurance.27 Due to this, private 
insurance to cover out-of-pocket expenses is considered to be linked to Mexicans 
with higher socioeconomic status.27 Public healthcare is fully or partially subsidized 
by the federal government through INSABI for individuals without employment, 
IMSS for those employed, and the ISSSTE for public employees.28  Brazil utilizes a 
national health system, Sistema Único de Saúde, providing its citizens with 



 

Berkeley Pharma Tech Journal of Medicine | 23 

decentralized, universal health coverage which is delivered at the state and municipal 
levels.28 North American nations utilize a mix of public and private programs, while 
Central and South America primarily concentrate on public programs that are fitted 
to meet the health needs of their populations. 
 
The COVID-19 pandemic has distributed all fields of healthcare. This has led to the 
postponement or cancellation of elective procedures such as cervical cancer 
screenings and clinic closures for reproductive healthcare. Telehealth has emerged 
as a crucial tool for accessing reproductive healthcare, particularly in areas where 
clinics have closed or reduced services.21 The pandemic has also intersected with 
political and social issues correlated to reproductive healthcare,21 namely stigmas 
surrounding ob-gyn procedures that continue to hinder women's access to critical 
services. i.e., reproductive surgeries such as termination of pregnancy or surgical 
sterilization were not initially prioritized by many national organizations, excluded 
from insurance coverage, and not permitted by healthcare institutions due to socio-
political views and stigma surrounding unintended pregnancy and termination.29 A 
study indicates that society associates reproductive healthcare with sexual relations, 
shaping stigmas that place limitations on unmarried women for using such services. 
Stigma regarding abortion is seen as a negative attribute that marks individuals as 
inferior to ideal womanhood and is based on a shared understanding that abortion 
is morally wrong or socially unacceptable.29 Additionally, there emerges the 
potential for internalized stigma as women report self-blaming and feeling shame 
for their HPV and/or cervical cancer diagnosis.29 In the United States, abortion 
continues to be stigmatized and has led to state-level restrictions. Moreover, 
Mexico’s population's religious values have led to a similar stigmatization as 
traditional beliefs about women’s role and sexuality render it difficult to access 
contraception or seek reproductive healthcare. However, as of September 2021, 
Mexico's Supreme Court ruled that it is unconstitutional to punish abortion as a 
crime, a watershed ruling that clears the way for the legalization of abortion across 
the country.27 Conversely, Brazil maintains that abortion is illegal except for certain 
legal exceptions. The country enforces comprehensive sexual and reproductive 
health policies according to national laws. Exacerbated by political polarization and 
push for restrictions, Brazil’s reproductive health systems have been further made 
difficult due to the inaccessibility of critical services. 
 
While Google Trends™ is a helpful tool to determine relative interest in a topic over 
a period in a region, there are intrinsic limitations to its usage. It does not accurately 
represent the entirety of internet search traffic for a topic because it is only 
harvesting data from Google searches. Furthermore, relative search volume (RSV) 
which is measured on a scale from 0 to 100 only demonstrates relative interest in a 



 

Berkeley Pharma Tech Journal of Medicine | 24 

topic. There is also potential for bias since not everyone can access technology or 
stable internet to make searches. Specifically, these individuals may also not be 
searching about telehealth at all due to this lack of access. Another consideration is 
that different countries may utilize different search languages and subsequently 
different terminology and communication channels. This makes it difficult to 
directly compare relative interest in a topic in different countries across different 
regions. 
 
The implementation of telehealth in obstetrics and gynecology is promising. It 
introduces new avenues to increase patient education before procedures, follow-up 
visits, and other opportunities. The incorporation of telemedicine for pregnant 
women has been associated with numerous advantages compared to exclusively in-
person care. For example, a retrospective observational cohort study on pregnant 
women who received exclusive in-person and alternate (telemedicine and in-person) 
care showed that women who received alternated care had similar maternal and 
perinatal outcomes to women who had received exclusively in-person care.30 
Interestingly, these women were also more likely to be admitted into antenatal 
follow-up programs earlier and obtain a more significant number of evaluations 
resulting in increased maternal satisfaction and decreased adverse outcomes such as 
perinatal mortality.30 In addition, they also experienced reduced unnecessary 
exposure to the hospital environment during pregnancy.30 The incorporation of 
telehealthcare also allows for increased utilization of web-based informational 
programs, an effective tool for patient education. These web-based programs 
empower patients to participate more effectively in medical decision-making, 
resulting in a higher likelihood of adherence to treatment plans. Increased 
preoperative knowledge can help to reduce anxiety levels before surgery. 
Furthermore, telehealth reduces several barriers which pregnant women might face 
as it may make care more affordable and a convenient method of healthcare delivery. 
Telehealth care allows patients to interact with physicians remotely regardless of 
time and day thereby increasing access.22 

 
With the promising nature of telehealth, addressing barriers regarding the 
integration of telehealth as a prominent part of healthcare systems in countries is 
essential. Such barriers include concerns about the lack of data privacy and security 
and the lack of rules and regulations concerning telehealth utilization.22 Addressing 
these issues by improving data privacy and security, outlining clear rules and 
regulations by the government concerning the use of telehealth and upgrading the 
infrastructure of telemedicine in hospitals and clinics will go a long way in advancing 
the capacity for integration of telehealth care.22 Another strategy that can facilitate 
telehealth incorporation is the reformation of medical school curricula to include 



Berkeley Pharma Tech Journal of Medicine | 25 

telehealth and telehealth care delivery components. Current medical practitioners 
can also be encouraged to participate in continuing medical education and 
continuing professional development to improve their knowledge and level of 
comfort in delivering Telehealth to patients; This would keep them abreast of the 
rapid advancement in this system.21 

6. Conclusion 

Telehealth has been of increased interest during the COVID-19 pandemic due to its 
role in helping the ill and immunocompromised receive care without concerns of 
further spreading the virus. This is a novel way to enable high-quality supportive 
care for a variety of patient populations. Using Google Trends™, our study found 
a significant rise in worldwide interest in obstetrics and gynecology and telehealth. 
Despite this, many physicians and patients have concerns due to regulatory, legal, 
reimbursement and privacy barriers. This has largely hindered the widespread 
adoption of telehealth. Previous studies have shown that there are many barriers to 
telehealth uptake specifically for surgical specialties and generally due to the lack of 
adequate healthcare infrastructure in many countries. Telehealth in surgical 
specialties also varies from other specialties as its primary use would likely be for 
preoperative assessment as well as evaluation and follow-ups post-surgery. This 
study strongly highlights the interest in telehealth for obstetrics and gynecology and 
potential of telehealth applications for surgical specialties globally. 



References

1. Chao GF, Li KY, Zhu Z, et al. Use of
telehealth by surgical specialties during the
covid-19 pandemic. JAMA Surgery.
2021;156(7):620-626.10.1001/jamasurg.2021.
0979

2. DeNicola N, Grossman D, Marko K, et al.
Telehealth interventions to improve obstetric
and gynecologic health outcomes: a systematic
review.Obstet Gynecol.
2020;135(2):371-382.10.1097/AOG.00000000
00003646

3. Halder GE, White AB, BrownHW, et al. A
telehealth intervention to increase patient
preparedness for surgery: a randomized trial. Int
Urogynecol J.
2022;33(1):85-93.10.1007/s00192-021-04831-w

4. Almathami HKY,Win KT,
Vlahu-Gjorgievska E. Barriers and facilitators
that in�uence telemedicine-based, real-time,
online consultation at patients’ homes:
systematic literature review. Journal of
Medical Internet Research.
2020;22(2):e16407.10.2196/16407

5. SallamM. Covid-19 vaccine hesitancy
worldwide: a concise systematic review of vaccine
acceptance rates.Vaccines.
2021;9(2):160.10.3390/vaccines9020160

6. Kapoor A, Guha S, Kanti Das M, Goswami KC,
Yadav R. Digital healthcare: The only solution for
better healthcare during COVID-19 pandemic?
Indian Heart Journal.
2020;72(2):61-64.10.1016/j.ihj.2020.04.001

7. Akintunde TY, Akintunde OD,Musa TH, et al.
Expanding telemedicine to reduce the burden on

the healthcare systems and poverty in Africa for a
post-coronavirus disease 2019 (COVID-19)
pandemic reformation.Glob Health J.
2021;5(3):128-134.10.1016/j.glohj.2021.07.006

8. Tozour JN, Bandremer S, Patberg E, et al.
Application of telemedicine video visits in a
maternal-fetal medicine practice at the epicenter of
the COVID-19 pandemic.American Journal of
Obstetrics & GynecologyMFM.
2021;3(6):100469.10.1016/j.ajogmf.2021.100469

9. Aziz A, Zork N, Aubey JJ, et al. Telehealth for
high-risk pregnancies in the setting of the
covid-19 pandemic. Am J Perinatol.
2020;37(8):800-808.10.1055/s-0040-1712121

10. Rovetta A. Reliability of google trends:
analysis of the limits and potential of web
infoveillance during covid-19 pandemic and for
future research. Frontiers in ResearchMetrics
and Analytics. 2021;6. Accessed April 11, 2023.
https://www.frontiersin.org/articles/10.3389/fr
ma.2021.670226

11. Satpathy P, Kumar S, Prasad P. Suitability
of google trendsTM for digital surveillance
during ongoing covid-19 epidemic: a case study
from india.DisasterMed Public Health
Prep.:1-10. 10.1017/dmp.2021.249

12. E�enberger M, Kronbichler A, Shin
JI, Mayer G, Tilg H, Perco P. Association
of the covid-19 pandemic with internet
search volumes: a google trendstm
analysis. Int J Infect Dis.
2020;95:192-197.10.1016/j.ijid.2020.04.
033

13. Yuan X, Xu J, Hussain S, Wang H, Gao N,
Zhang L. Trends and prediction in daily new cases
and deaths of covid-19 in the united states: an

Berkeley Pharma Tech Journal of Medicine | 26

https://www.frontiersin.org/articles/10.3389/frma.2021.670226


internet search-interest based model. Explor Res
Hypothesis Med. 2020;5(2):1-6.
10.14218/ERHM.2020.00023

14. Kurian SJ, Bhatti A ur R, Alvi MA, et al.
Correlations between covid-19 cases and google
trends data in the united states: a state-by-state
analysis.Mayo Clin Proc. 2020;95(11):2370-2381.
10.1016/j.mayocp.2020.08.022

15. SchootmanM, Toor A, Cavazos-Rehg P, et al.
The utility of Google Trends data to examine
interest in cancer screening. BMJ Open.
2015;5(6):e006678.
10.1136/bmjopen-2014-006678

16. Ali SA, Arif TB, Maab H, et al. Global
interest in telehealth during covid-19
pandemic: an analysis of google trendsTM.
Cureus. 2020;12(9). 10.7759/cureus.10487

17. Faq about google trends data - trends help.
Accessed April 11, 2023.
https://support.google.com/trends/answer/43
65533?hl=en

18. WHO coronavirus (COVID-19) dashboard.
Accessed April 11, 2023. https://covid19.who.int

19.Chan YH. Biostatistics 104: correlational
analysis. SingaporeMed J. 2003;44(12):614-619.

20. Chang JE, Lai AY, Gupta A, Nguyen AM,
Berry CA, Shelley DR. Rapid transition to
telehealth and the digital divide: implications for
primary care access and equity in a post-covid era.
Milbank Q.
2021;99(2):340-368.10.1111/1468-0009.12509

21.Doraiswamy S, Abraham A,Mamtani R,
Cheema S. Use of telehealth during the covid-19
pandemic: scoping review. J Med Internet Res.

2020;22(12):e24087.10.2196/24087

22. Garfan S, Alamoodi AH, Zaidan BB, et al.
Telehealth utilization during the Covid-19
pandemic: A systematic review. Comput Biol
Med.
2021;138:104878.10.1016/j.compbiomed.2021.1
04878

23. Hollander JE, Carr BG. Virtually perfect?
Telemedicine for covid-19.NEngl JMed.
2020;382(18):1679-1681.10.1056/NEJMp20035
39

24. Bokolo AJ. Exploring the adoption of
telemedicine and virtual software for care of
outpatients during and after COVID-19
pandemic. Ir J Med Sci.
2021;190(1):1-10.10.1007/s11845-020-02299-z

25. Chu C, Cram P, Pang A, Stamenova V,
Tadrous M, Bhatia RS. Rural telemedicine use
before and during the covid-19 pandemic:
repeated cross-sectional study. J Med Internet
Res. 2021;23(4):e26960.10.2196/26960

26. Haldane V, De Foo C, Abdalla SM, et al. Health
systems resilience in managing the COVID-19
pandemic: lessons from 28 countries.NatMed.
2021;27(6):964-980.10.1038/s41591-021-01381-y

27. Juan López M,Martínez Valle A, Aguilera N.
Reforming the Mexican health system to achieve
e�ective health care coverage.Health Systems &
Reform.
2015;1(3):181-188.10.1080/23288604.2015.10589
99

28. Castro R. Health care delivery system:
mexico. In: CockerhamWC, Dingwall R, Quah
S, eds. TheWiley Blackwell Encyclopedia of
Health, Illness, Behavior, and Society. JohnWiley

Berkeley Pharma Tech Journal of Medicine | 27



& Sons, Ltd;
2014:836-842.10.1002/9781118410868.wbehibs
101

29. Bruno B, Shalowitz DI, Arora KS. Ethical
challenges for women’s healthcare highlighted by
the COVID-19 pandemic. J Med Ethics.
Published online October
2020:medethics-2020-106646.10.1136/medethic
s-2020-106646

30. Escobar MF, Gallego JC, Echavarria MP, et
al. Maternal and perinatal outcomes in mixed
antenatal care modality implementing
telemedicine in the southwestern region of
Colombia during the COVID-19 pandemic.
BMCHealth Serv Res.
2023;23(1):259.10.1186/s12913-023-09255-4

Berkeley Pharma Tech Journal of Medicine | 28




