2026 - Obstech

h1. _Obstech - Tele-CTG_: Conceção e prototipagem dum serviço de telemedicina em obstetrícia

Unidade Curricular de +Telemedicina e e-Saúde+

Faculdade de Engenharia da Universidade do Porto

*Nome dos autores*:

Inês Vasconcelos - up202314982

Maria Videira - up202510611

Marta Filipe - up20250464

h2. *0. Abstract*

The _Obstech – Tele-CTG_ project aims to conceive and prototype an innovative telemedicine service in the field of obstetrics, focused on remote cardiotocography (CTG) monitoring during pregnancy. Cardiotocography is an essential clinical exam that simultaneously records fetal heart rate and uterine activity, traditionally performed in hospital settings.

This project proposes a hybrid model composed of a portable signal acquisition device and an integrated digital platform with two distinct interfaces: one designed for the pregnant woman (patient-facing) and another for healthcare professionals (clinical-facing). The approach is centered on user interviews and functional mockup development to validate the system's utility and feasibility.

The solution addresses a clear gap in the current market, where existing solutions are either highly reliable but hospital-bound, or accessible but lacking clinical integration and intelligent data analysis. Obstech bridges these two extremes by combining clinical-grade CTG monitoring with a patient-centered digital experience.

*Keywords:* Telemedicine, Obstetrics, Cardiotocography, Remote Monitoring, eHealth, Prototyping

h2. *1. Introduction*

h3. *1.1 What is _Obstech – Tele-CTG_?*

_Obstech – Tele-CTG_ is a telemedicine service designed for remote fetal monitoring through cardiotocography (CTG) in home environments. It consists of a portable or wearable device that captures fetal heart rate and uterine activity signals, combined with a digital platform that transmits and displays this data securely to healthcare providers.

The system operates on a hybrid model: the pregnant woman uses the device at home while her clinical data is continuously available to her medical team through a dedicated professional interface. This eliminates the need for frequent hospital visits while maintaining the clinical quality and continuity of fetal monitoring.

Rather than being only a device or only a mobile application, Obstech is conceived as an integrated telemedicine service that connects home-based fetal monitoring with clinical follow-up, combining signal acquisition, patient engagement and professional decision support.

h3. *1.2 The Concept of Remote CTG Monitoring*

Cardiotocography CTG is the simultaneous recording of the fetal heart rate (FHR) and uterine contractions. It is a standard clinical tool used to assess fetal well-being during pregnancy and labor. In its traditional form, CTG requires the pregnant woman to visit a hospital or clinic, where sensors are placed on the abdomen and connected to a monitor.

Remote CTG monitoring refers to the use of portable or wearable sensors to perform CTG outside the clinical setting, typically at home, with data transmitted electronically to healthcare providers. This approach enables continuous or on-demand monitoring, reducing the burden on hospital services and improving access for patients in remote or underserved areas.

In this context, remote CTG monitoring represents a relevant application of telemedicine, as it enables clinical data to be collected outside the hospital while remaining accessible to healthcare professionals. This supports a more continuous, accessible and patient-centered model of pregnancy follow-up.

h3. *1.3 Project Motivation and Objectives*

The motivation for this project stems from the clear limitations of current CTG monitoring practice:

* Frequent and inconvenient hospital visits for routine monitoring;

* Episodic rather than continuous fetal surveillance;

* Overloaded obstetrics departments;

* Limited autonomy for the pregnant woman;

* Poor access for patients in rural or geographically isolated areas.

These limitations create the need for a hybrid solution capable of reducing unnecessary hospital visits while preserving clinical supervision and data quality.

The main objectives of _Obstech – Tele-CTG_ are:

* Develop a remote CTG monitoring solution usable in a home environment;

* Review the state of the art and identify gaps in existing solutions;

* Contact relevant stakeholders (pregnant women, obstetricians, nurses) for requirements gathering;

* Design functional mockups of both the patient and clinical interfaces;

* Validate the proposed system's utility, usability, and clinical viability.

h2. *2. Market Assessment Study*

h3. *2.1 Review of Existing Solutions*

A review of existing fetal and maternal monitoring solutions was conducted in order to understand the current technological landscape and identify opportunities for differentiation. The analysed solutions included hospital-based CTG systems, portable fetal monitoring devices, wearable technologies and remote monitoring platforms.

The comparison was based on five criteria considered relevant for the Obstech concept: home use capability, full CTG measurement, clinical interface, patient interface and automatic data analysis. These criteria were selected because they represent the main dimensions required for a complete telemedicine solution in obstetrics: accessibility, clinical value, professional integration, patient-centered design and decision-support potential.

_Table 1 – Comparative analysis of existing solutions_

!Tabela_1.png(300)!

The comparative analysis shows that existing solutions tend to be divided into two main groups. Hospital-centered systems, such as Avalon CL, Sonicaid Team3 and OBIX, provide strong clinical reliability and professional integration, but are mainly designed for use in clinical environments. In contrast, home-based or portable solutions, such as HeraBEAT, PregnaBit Pro, Sense4Baby, iCTG, INVU and PreTel Juno, improve accessibility but often present limitations regarding full CTG acquisition, patient interface design, intelligent analysis or integration with clinical workflows.

This analysis confirms that there is still space for a hybrid solution capable of combining home accessibility with clinical robustness and a meaningful patient-facing experience.

h3. *2.2 Analysis of Available Apps*

Beyond dedicated hardware systems, several mobile applications exist for pregnancy monitoring. These can be broadly grouped into three categories:

* Consumer wellness apps (e.g., baby heartbeat apps): These use the smartphone microphone to detect fetal sounds. They lack clinical accuracy and are not validated for medical use.

* Companion apps for medical devices: Applications paired with CTG devices (e.g., HeraBEAT app, PregnaBit app) that display data from dedicated sensors. These have better accuracy but typically offer limited clinical integration and a basic user experience.

* Hospital platform apps: Web-based or mobile interfaces for clinical staff to access patient monitoring data remotely (e.g., OBIX, Sonicaid). These are clinically robust but are not designed for patient use.

A key finding across all app categories is the consistent absence of a well-designed, patient-centered interface that makes clinical data meaningful and accessible to the pregnant woman without requiring medical expertise.

h3. *2.2 Analysis of Available Apps*

The market analysis reveals a consistent pattern: existing solutions cluster at opposite ends of a spectrum. Clinical systems offer high reliability but require hospital attendance; home devices offer convenience but lack clinical depth and integration.

The identified gaps that _Obstech_ aims to address are:

* No solution combines full CTG monitoring (FHR + uterine activity) in the home setting with a strong clinical platform;

* Patient-facing interfaces are universally underdeveloped — data is displayed without meaningful context for the pregnant woman;

* Automatic analysis and intelligent alerting is either absent or limited in home-use solutions;

* No solution offers a true hybrid model with continuous bidirectional communication between the patient and the clinical team;

* Digital pregnancy records (a unified 'digital pregnancy booklet') are absent from all reviewed solutions.

These gaps define the innovation space for Obstech and directly inform its differentiating features.

h2. *3. Structure*

h3. *3.1 Requirements Gathering*

Requirements for the Obstech system were gathered through a combination of literature review, analysis of existing solutions, and direct contact with end users and healthcare professionals. The requirements gathering process followed an iterative approach, with initial requirements refined based on stakeholder feedback.

Requirements were classified into functional requirements (what the system must do) and non-functional requirements (how the system must perform), and further divided by interface: patient-facing and clinician-facing.

*Key functional requirements identified*:

* Real-time transmission of CTG data (FHR + uterine activity) from home to clinical platform;

* Patient interface: simplified CTG summaries, digital pregnancy booklet, gestational timeline, exam history;

* Clinical interface: full CTG traces, structured patient history, report generation, multi-patient dashboard, alert system;

* Secure and encrypted data storage and transmission (GDPR compliant);

* Interoperability with existing hospital systems (HL7/FHIR standards).

h3. *3.2 Interviews and Iterations*

As Obstech is a user-centered telemedicine solution, stakeholder involvement was considered essential during the conception and prototyping phase. The main purpose of the interview process was to validate the relevance of the problem, identify practical needs from both patient and clinical perspectives, and refine the functional requirements of the proposed system.

A qualitative exploratory approach was adopted, based on semi-structured interviews with two main stakeholder groups: pregnant women or recent mothers, representing the patient perspective, and healthcare professionals involved in pregnancy monitoring, representing the clinical perspective. This method was selected because it allows participants to freely describe their experiences, concerns and expectations, while still ensuring that key topics are addressed consistently across interviews.

The interviews focused on five main dimensions: current experience with CTG monitoring, perceived difficulties associated with hospital-based monitoring, willingness to use a remote CTG solution, expected functionalities in a patient-facing application, and clinical requirements for a professional monitoring platform. Questions were adapted according to the participant profile, with patients being asked mainly about usability, reassurance and communication, while healthcare professionals were asked about clinical workflow, signal reliability, alerts, data interpretation and patient safety.

All quotes presented in this section are anonymized and translated into English where necessary, preserving the meaning of the original statements. The quotes are representative excerpts from the stakeholder feedback collected during the exploratory validation process.

From the patient perspective, the feedback confirmed that CTG monitoring is generally perceived as clinically important, but also associated with inconvenience, anxiety and dependency on hospital availability. Participants valued the possibility of performing monitoring at home, particularly if the system remained connected to healthcare professionals and did not place the responsibility of clinical interpretation on the pregnant woman. A recurring concern was that medical data should be presented in a simple and reassuring way, avoiding technical terminology that could generate unnecessary anxiety.

One participant described this need as follows:

“When I do an exam, I do not necessarily need to understand every medical detail. What I really want to know is whether everything seems normal and whether my doctor has access to the result.”

Another participant emphasized the burden of repeated hospital visits:

“Near the end of pregnancy, going to the hospital several times can become tiring and stressful. If part of that monitoring could be done safely at home, it would make the process much easier.”

These findings directly influenced the design of the patient-facing application. As a result, the app was designed to prioritize a simple dashboard, plain-language CTG summaries, pregnancy progression, exam history, notifications and a digital pregnancy booklet. The patient interface deliberately avoids displaying complex raw clinical traces as the main element. Instead, it presents summarized and contextualized information, while ensuring that complete data remains available to the healthcare team.

From the clinical perspective, healthcare professionals recognized the potential of remote CTG monitoring to improve accessibility and reduce unnecessary hospital visits, especially for pregnant women requiring regular follow-up or living far from healthcare facilities. However, they also stressed that remote monitoring should not compromise clinical rigor. The professional interface must therefore provide complete CTG traces, signal quality indicators, patient history, previous monitoring sessions and clear alert prioritization.

One healthcare professional highlighted this distinction:

“For the patient, the information should be simple. For the clinician, it cannot be simplified too much. We need access to the complete CTG trace, the clinical context and the evolution over time.”

Another important concern was related to signal quality and false alarms:

“In remote monitoring, signal quality is critical. Before generating an alert, the system must be able to distinguish between a real clinical concern and a poor-quality recording.”

This feedback reinforced the need to include signal quality validation as a core system functionality. Consequently, the Obstech workflow was refined to include technical validation before clinical interpretation. Poor signal acquisition, incomplete transmission or device connection problems are treated as technical alerts, while abnormal fetal heart rate patterns or concerning uterine activity are treated as clinical alerts.

Healthcare professionals also emphasized that automatic analysis should support, but never replace, clinical decision-making. Therefore, the system was positioned as a clinical decision-support tool rather than an autonomous diagnostic system.

This was summarized by one professional as follows:

“The platform can help us prioritize cases and detect patterns faster, but the final interpretation must always remain with the healthcare professional.”

The interviews also contributed to the refinement of the clinical platform. Initially, the concept was mainly focused on CTG visualization and report generation. After the feedback, additional features were reinforced, including multi-patient monitoring, structured patient history, alert categorization, clinical notes, patient contact and trend analysis across multiple CTG sessions. These elements were considered important to integrate the solution into a realistic clinical workflow.

The concept of the digital pregnancy booklet was also validated during the interviews. Patients considered it useful to have pregnancy-related information centralized in a single place, including CTG summaries, appointments, clinical notes and pregnancy evolution. This feature was therefore maintained as one of the differentiating elements of Obstech, since many existing solutions focus mainly on monitoring data and do not provide a complete patient-centered pregnancy record.

Based on the interview feedback, the mockups were iteratively refined. The main changes included simplifying the language used in the patient app, improving the visibility of the latest CTG result, adding clearer navigation to the pregnancy booklet, reinforcing notifications and messages, and expanding the clinical dashboard to include alert status, patient history and monitoring trends. These iterations helped align the prototype with the expectations of both end users and healthcare professionals.

The main requirements refined through the interview process were:

* The patient interface must present information in simple, reassuring and non-technical language;

* The clinical platform must provide access to complete CTG traces and detailed patient history;

* Signal quality must be validated before data interpretation;

* Alerts must be separated into technical alerts and clinical alerts;

* The system must support secure communication between the pregnant woman and the healthcare team;

* The digital pregnancy booklet should centralize pregnancy evolution, exams and relevant clinical information;

* Automatic analysis should support clinical prioritization without replacing professional judgment;

* The solution must be intuitive enough for home use while maintaining clinical reliability.

Overall, the interview process confirmed the relevance of the Obstech value proposition. The findings showed that the proposed solution addresses not only a logistical problem, related to hospital visits and access to monitoring, but also an emotional and informational need, related to reassurance, autonomy and continuity of care during pregnancy. At the same time, the clinical feedback reinforced the importance of maintaining data quality, professional oversight and integration into healthcare workflows.

Therefore, the interviews validated the hybrid positioning of Obstech: a remote CTG monitoring solution that combines home-based accessibility, a patient-centered mobile application and a clinically robust platform for healthcare professionals.

h3. *3.3 Final Features and Specifications*

Based on the requirements gathering process and interview iterations, the final feature set for the Obstech prototype is defined as follows:

*Patient Interface (App)*:

* Digital pregnancy booklet — unified view of all pregnancy information;

* CTG session results displayed in plain language with visual summaries;

* Gestational timeline showing week-by-week pregnancy progression;

* Exam history and results archive;

* Push notifications for alerts or messages from the clinical team;

* Secure in-app messaging with the healthcare provider.

*Clinical Interface (Web Platform)*:

* Multi-patient dashboard with real-time monitoring status;

* Full CTG trace visualization (cardiotocogram viewer);

* Structured clinical history per patient;

* Automated report generation (exportable PDF);

* Alert system for values outside clinical thresholds;

* Trend analysis and comparison of CTG sessions over time;

* Clinical decision support (pattern flagging, risk indicators).

h3. *3.4 Use Cases*

This section presents the use cases identified for the Obstech – Tele-CTG system. The use case diagram illustrates the interactions between the different system actors and the functionalities provided by the platform, offering a clear and structured view of the project's functional requirements.

h4. *3.4.1 System Actors*

The following actors were identified:

* Pregnant Woman — primary user of the mobile interface, who performs CTG monitoring at home, consults results and communicates with the clinical team.

* Healthcare Professional — physician or nurse who monitors patients, analyses monitoring data, generates clinical reports, and manages notes and alerts.

* Wearable Device — non-human actor responsible for acquiring CTG signals and transmitting them to the platform.

* Obstech System / Platform — non-human actor that processes, validates and stores received data, and generates automatic alerts.

* Administrator — responsible for user management, permissions, and integration with external hospital systems.

h4. *3.4.2 Use Case Diagram*

!Use_Cases.jpeg!

_Figure 1 – Use case diagram of the Obstech – Tele-CTG system_

h4. *3.4.3 Detailed Use Case Descriptions*

The following tables describe each identified use case in detail, including the primary actor, pre-conditions, main flow of events, alternative flows, and post-conditions.

*UC01 - Log In*

_Table UC01 – Log In_

!UC01.png!

*UC02 - Perform CTG Monitoring*

_Table UC02 – Perfom CTG Monitoring_

!UC02.png!

*UC03 - View CTG Exam Summary*

_Table UC03 - View CTG Exam Summary_

!UC03.png!

*UC04 - View Monitoring History*

_Table UC04 - View Monitoring History_

!UC04.png!

*UC05 - Track Pregnancy Progress*

_Table UC05 - Track Pregnancy Progress_

!UC05.png!

*UC06 - Consult Digital Pregnancy Booklet*

_Table UC06 - Consult Digital Pregnancy Booklet_

!UC06.png!

*UC07 – Receive Notifications*

_Table UC07 - Receive Notifications_

!UC07.png!

*UC08 – Consult Full CTG Records*

_Table UC08 - Consult Full CTG Records_

!UC08.png!

*UC09 – Consult Patient Clinical History*

_Table UC09 - Consult Patient Clinical History_

!UC09.png!

*UC10 – Analyse Monitoring Data*

_Table UC10 - Analyse Monitoring Data_

!UC10.png!

*UC11 – Generate Clinical Report*

_Table UC11 - Generate Clinical Report_

!UC11.png!

*UC12 – Manage Clinical Notes*

_Table UC12 - Manage Clinical Notes_

!UC12.png!

*UC13 – Contact Patient*

_Table UC13 - Contact Patient_

!UC13.png!

*UC14 – Manage Profile and Settings*

_Table UC14 - Manage Profile and Settings_

!UC14.png!

*UC15 – Consult Help and Support*

_Table UC15 - Consult Help and Support_

!UC15.png!

*UC16 – Acquire and Transmit CTG Signals (Device)*

_Table UC16 - Acquire and Transmit CTG Signals (Device)_

!UC16.png!

*UC17 – Manage Users (Administrator)*

_Table UC17 - Manage Users (Administrator)_

!UC17.png!

h3. *3.5 Activity Diagrams*

h2. *4. Design and Functionalities*

h3. *4.1 Mockup Building* - *+CONFIRMAR COM FIGMA + COLOCAR FOTOS!!!+*

Mockups were developed for both the patient-facing mobile application and the clinician-facing web platform. The design process followed a user-centered approach, with mockup iterations informed by the stakeholder interviews described in Section 3.2.

*Patient App — Key screens*:

* Home screen / Dashboard: gestational week, next appointment, quick access to recent CTG result;

* CTG Result screen: visual summary of last session with plain-language interpretation;

* Pregnancy Booklet: timeline with all exams, results, and clinical notes;

* Notifications: alerts and messages from the clinical team;

* Profile & Settings: personal data, device pairing, language preferences.

*Clinical Platform — Key screens*:

* Patient list dashboard: all monitored patients with status indicators;

* Patient profile: full clinical history, gestational record, device status;

* CTG viewer: interactive trace visualization with annotation tools;

* Alerts panel: flagged events requiring clinical attention;

* Reports: generation, preview, and export of clinical reports.

h3. *4.2 Device Integration*

h3. *4.3 Data Consent*

Data consent is a critical component of the Obstech system, since the solution involves the collection, transmission and storage of sensitive maternal and fetal health data. For this reason, privacy, security and informed consent were considered essential requirements from the design stage.

Before using the system, the pregnant woman must be clearly informed about what data is collected, why it is collected, who can access it and how it will be used. The consent process should be integrated into the patient application in a simple and transparent way, ensuring that the user understands the purpose of remote CTG monitoring and the role of the healthcare team.

The data collected by Obstech may include:

* personal identification data;

* pregnancy-related information;

* CTG monitoring records;

* fetal heart rate data;

* uterine activity data;

* monitoring history;

* clinical notes and reports;

* communication between the patient and healthcare professionals;

* technical information related to device connection and signal quality.

The system should follow the principle of data minimization, meaning that only the information necessary for remote monitoring and clinical follow-up should be collected. Additionally, access to the data should be limited according to the role of each user. For example, pregnant women should access their own information and simplified monitoring summaries, while healthcare professionals should access detailed clinical data only for patients under their care.

The main data protection requirements considered for Obstech are:

* explicit informed consent before data collection;

* clear explanation of the purpose of data use;

* possibility for the patient to review consent information;

* secure authentication for both patients and professionals;

* encrypted data transmission between the app, platform and clinical interface;

* encrypted storage of sensitive health data;

* role-based access control;

* audit logs to record access to clinical information;

* possibility of correcting or deleting data according to applicable regulations;

* compliance with GDPR principles.

In the patient app, the consent process should be presented in plain language. Instead of using only legal or technical terminology, the application should explain the process in a clear and understandable way. For example, the user should be informed that CTG data will be shared with authorized healthcare professionals to support remote pregnancy monitoring.

In the clinical platform, data consent is reflected through access control and professional responsibility. Healthcare professionals should only access the records of patients assigned to them, and all access should be traceable. This helps protect patient privacy and reinforces accountability in the use of sensitive health information.

Data consent is therefore not treated as a separate administrative form, but as an integral part of the Obstech service. By incorporating consent, security and privacy into the design of the system, Obstech aims to ensure that remote monitoring is not only clinically useful, but also ethically responsible and trustworthy for users.

h2. *5. Implementation*

The implementation of Obstech – Tele-CTG focused on the development of a functional and interactive prototype capable of demonstrating the main user flows of the proposed telemedicine service. Since the scope of the project is centered on the conception and prototyping of a remote obstetric monitoring solution, the implementation prioritized interface design, system logic, interaction between users and the representation of the monitoring workflow.

The prototype was developed through an interactive Figma mockup, including two main components: a mobile application for the pregnant woman and a web-based clinical platform for healthcare professionals. These two interfaces were designed to represent the dual nature of the Obstech system: a simple, reassuring and accessible experience for the patient, and a more complete, clinically oriented environment for professionals.

The patient-facing application includes the main screens required for home-based CTG monitoring. These include login, home dashboard, CTG exam summary, monitoring history, pregnancy evolution, digital pregnancy booklet, notifications, profile, settings and support. The purpose of this interface is to allow the pregnant woman to interact with the system in a simple and intuitive way, without requiring medical expertise. For this reason, clinical information is translated into plain-language summaries and visual indicators, while complete CTG data remains available to the healthcare team.

The clinical platform was designed to support remote follow-up and clinical decision-making. It includes a professional dashboard, patient list, patient profile, monitoring records, clinical alerts, reports, messages and settings. This interface allows healthcare professionals to access structured patient information, review CTG monitoring sessions, identify relevant alerts, generate reports and maintain communication with the pregnant woman.

From a system perspective, the prototype represents the expected workflow of a complete remote CTG monitoring session. The pregnant woman performs the monitoring at home using a wearable CTG device. The device acquires fetal heart rate and uterine activity signals and transmits them to the mobile application. The data is then sent securely to the Obstech platform, where signal quality and transmission status are validated before being made available to the healthcare professional.

Although the current prototype does not include a fully functional backend or real biomedical signal acquisition, it simulates the main interactions required for the system to operate. These include CTG session visualization, monitoring history, alert representation, patient information management and report access. This approach is appropriate for the current stage of the project, as it allows the validation of the service concept, user experience and functional structure before technical development and clinical testing.

The planned technical architecture of the complete Obstech system would include:

* a wearable CTG device for fetal heart rate and uterine activity acquisition;

* Bluetooth Low Energy communication between the device and the patient’s smartphone;

* a mobile application for session control, patient interaction and data transmission;

* a cloud-based backend for secure storage, processing and synchronization of monitoring data;

* a clinical web platform for healthcare professionals;

* encrypted data transmission and storage;

* future integration with hospital information systems using healthcare interoperability standards such as HL7/FHIR.

The prototype therefore demonstrates the core value of the Obstech solution: connecting the pregnant woman, the home environment and the healthcare team through an integrated telemedicine workflow. Instead of being limited to a static visual mockup, the implementation represents the main functional interactions of the proposed service and supports the evaluation of usability, feasibility and clinical relevance.

h2. *6. Project Management*

Project management for Obstech – Tele-CTG was conducted using Redmine, the project management platform designated for the course. Redmine was used to organize the development process, distribute tasks among team members, monitor progress and document the main stages of the project.

The work was structured into milestones corresponding to the main phases of the project. This allowed the team to follow a progressive and organized development process, from the initial research phase to the final report and presentation.

The main project milestones were:

* *Milestone 1* – State of the Art Review: identification and analysis of existing fetal monitoring solutions, including hospital-based CTG systems, home monitoring devices and digital platforms;

* *Milestone 2* – Market Assessment: comparison of existing solutions, identification of gaps and definition of the opportunity for Obstech;

* *Milestone 3* – Requirements and Use Cases: definition of functional requirements, non-functional requirements and UML use case diagrams;

* *Milestone 4* – Stakeholder Interviews: preparation, execution and analysis of interviews with pregnant women/recent mothers and healthcare professionals;

* *Milestone 5* – Mockup Design: development of the patient-facing mobile application and the clinical platform;

* *Milestone 6* – Prototype Interaction: creation of interactive flows in Figma to simulate the main user journeys;

* *Milestone 7* – Report and Presentation: preparation of the final written report, teaser, presentation structure and oral presentation materials.

Tasks were divided according to the main project components: research and benchmarking, market assessment, requirements definition, use case modeling, mockup design, implementation of interactive flows, report writing and presentation preparation. This distribution allowed each team member to contribute to specific parts of the project while maintaining coordination across the overall system concept.

Redmine was particularly useful for tracking the evolution of the project and ensuring that the final solution remained aligned with the initial objectives. The platform supported task assignment, monitoring of progress and organization of deliverables. It also helped the team identify pending work, such as completing the mockup, refining the report sections, adding diagrams and preparing the final presentation.

The project followed an iterative approach. Initial ideas were refined after the analysis of existing solutions, stakeholder feedback and mockup development. This iterative process was important because Obstech is a user-centered telemedicine solution, requiring alignment between patient needs, clinical requirements and technical feasibility.

Overall, project management contributed to maintaining a structured workflow, distributing responsibilities and ensuring that the final prototype and report were developed in a coherent and progressive way.

h2. *7. Problems/Difficulties*

During the development of Obstech – Tele-CTG, several challenges were identified. These difficulties were related to the clinical nature of the problem, the technological complexity of remote CTG monitoring, the need to balance patient and professional requirements, and the limitations of the project scope.

One of the first challenges was understanding the clinical context of cardiotocography and remote fetal monitoring. CTG is a clinically relevant exam that involves the interpretation of fetal heart rate and uterine activity, and therefore it was necessary to ensure that the proposed solution respected the importance of clinical supervision. This required the team to carefully distinguish between information that could be safely simplified for the pregnant woman and information that should remain available only to healthcare professionals.

A second difficulty was defining the role of the automatic analysis component. Although intelligent alerts and decision-support tools are valuable features, the team recognized that the system should not be presented as an autonomous diagnostic tool. Instead, Obstech was positioned as a clinical support system, where automatic alerts and signal quality validation help professionals prioritize cases, but final interpretation remains the responsibility of the healthcare team.

Another challenge was related to the design of the patient-facing interface. The app needed to be simple, reassuring and understandable, while still being connected to a clinically meaningful monitoring process. Too much clinical detail could increase anxiety or confusion, while too little information could make the app feel incomplete or unhelpful. The final design therefore focused on plain-language summaries, visual organization, pregnancy evolution, monitoring history and a digital pregnancy booklet.

The clinical platform presented a different design challenge. Healthcare professionals require more detailed information, including complete CTG records, patient history, alerts, reports and monitoring trends. Therefore, the platform needed to be more data-rich than the patient app, while still remaining organized and easy to navigate. Balancing clinical depth with interface simplicity was one of the central design difficulties.

The selection and conceptualization of the wearable device also represented a challenge. Since the project did not involve the physical development of biomedical hardware, the device had to be described at a conceptual level while remaining technically plausible. The proposed device was therefore defined as a wearable CTG acquisition system capable of collecting fetal heart rate and uterine activity signals and transmitting them to the patient application.

Data privacy and security were also important concerns. Maternal and fetal health data are highly sensitive, which means that any real implementation of Obstech would need to comply with data protection regulations, including GDPR. This required the inclusion of privacy-related requirements such as informed consent, encrypted transmission, role-based access and secure storage.

Finally, the project faced the limitation of being a prototype rather than a fully implemented medical device or clinical platform. The current implementation demonstrates the service concept and main user flows through an interactive mockup, but it does not yet include real signal acquisition, backend infrastructure, hospital integration or clinical validation. These limitations were acknowledged and included as part of the future work.

Despite these challenges, the difficulties encountered helped refine the project and made the final proposal more realistic. They reinforced the need for a hybrid solution that combines usability, clinical oversight, technical feasibility and future regulatory awareness.

h2. *8. Conclusions*

The Obstech – Tele-CTG project addresses a relevant challenge in maternal-fetal healthcare: the need to make cardiotocography monitoring more accessible, continuous and connected to clinical follow-up. Traditional CTG monitoring is mainly hospital-based, which can lead to frequent hospital visits, episodic monitoring, reduced autonomy for pregnant women and increased pressure on obstetric services.

The market assessment confirmed that existing solutions are divided between two main categories. On one side, hospital-based systems provide clinical reliability and complete CTG data but are limited in accessibility. On the other side, home-based solutions improve convenience but often lack clinical integration, intelligent analysis, bidirectional communication or a well-developed patient interface. This gap creates an opportunity for a hybrid telemedicine solution such as Obstech.

The proposed system combines three main components: a wearable CTG device, a mobile application for pregnant women and a clinical platform for healthcare professionals. Together, these components create a remote monitoring workflow that connects the home environment with the healthcare system. The patient app focuses on simplicity, reassurance and understandable information, while the professional platform provides access to structured clinical data, monitoring records, alerts and reports.

The use case analysis and mockup development helped define the main interactions of the system. The pregnant woman can perform monitoring, consult CTG summaries, access monitoring history, follow pregnancy evolution, receive notifications and use a digital pregnancy booklet. The healthcare professional can consult complete CTG records, analyse monitoring data, access clinical history, receive alerts, generate reports and contact the patient. The system also includes technical functions such as receiving device data, validating signal quality, validating transmission and sending technical alerts.

The final prototype demonstrates the core concept of Obstech as an integrated telemedicine service rather than a standalone device or application. It shows how remote CTG monitoring could be made more accessible for pregnant women while preserving clinical supervision and professional decision-making.

Overall, Obstech contributes to the modernization of pregnancy monitoring by proposing a model that bridges the gap between hospital-based fetal surveillance and home-based digital health. The project highlights the importance of designing telemedicine solutions that are not only technically feasible, but also clinically meaningful and centered on the needs of both patients and healthcare professionals.

h2. *9. Future Work*

Although the current project successfully defines and prototypes the Obstech concept, several future developments would be required before the solution could be implemented in a real clinical context.

The first future step would be to conduct usability testing with pregnant women, recent mothers and healthcare professionals. This would allow the evaluation of the clarity, usability and perceived usefulness of both the patient app and the clinical platform. Methods such as structured questionnaires, task-based testing and think-aloud sessions could be used to identify interface improvements and validate the user experience.

A second important step would be the technical development of a functional prototype. This would include the implementation of the mobile application, the clinical web platform, the backend infrastructure, database system and secure data transmission mechanisms. The current Figma prototype would therefore serve as the foundation for a future software implementation.

Another essential future development would be the integration of real biomedical signal acquisition. This would require the selection or development of a wearable CTG device capable of recording fetal heart rate and uterine activity in a home environment. The device would need to be tested for signal quality, usability, comfort, battery life, connectivity and reliability.

Clinical validation would also be necessary. Any future version of Obstech intended for real healthcare use would need to be compared with standard hospital CTG equipment to evaluate accuracy, reliability and safety. This would require collaboration with healthcare institutions and professionals specialized in obstetrics.

Artificial intelligence and automatic analysis could also be explored in future work. Machine learning algorithms could support CTG pattern recognition, signal quality assessment, risk indicators and alert prioritization. However, these tools should be developed as clinical decision-support mechanisms and not as replacements for healthcare professionals.

Integration with hospital information systems would also be an important future step. The use of interoperability standards such as HL7/FHIR would allow Obstech to connect with electronic health records and existing clinical workflows, improving continuity of care and avoiding fragmented information.

Regulatory and ethical aspects should also be further developed. As a solution involving maternal and fetal health data and potential medical device components, Obstech would need to comply with GDPR and, in a real implementation scenario, may require evaluation under the European Medical Device Regulation. Future work should therefore include a more detailed regulatory pathway and risk assessment.

Finally, the business and implementation model could be expanded. Future studies could explore whether Obstech would be more suitable as a hospital-provided service, a telemedicine platform integrated into public healthcare, a private maternity care solution, or a hybrid model. This would help define the most realistic pathway for adoption.

In summary, future work should focus on usability validation, functional software development, biomedical device integration, clinical validation, AI-based support tools, hospital interoperability and regulatory assessment. These steps would allow Obstech to evolve from a conceptual prototype into a clinically viable telemedicine solution for remote pregnancy monitoring.

h2. *10. Hyperlinks for App Mockup*

Interactive mockups for both the patient application and the clinical platform are available for review through the following links:

*Patient App Mockup (Figma):* https://www.figma.com/proto/znMYyLlW8g8Ft4tuAYhP5a/A-equipe-de-up202502464-team-library?node-id=3312-2&t=RihzMLqr8VuII7PF-1

*Clinical Platform Mockup (Figma):* https://www.figma.com/proto/znMYyLlW8g8Ft4tuAYhP5a/A-equipe-de-up202502464-team-library?node-id=3410-1307&p=f&t=sKPc6qg4GZ0flH44-1&scaling=scale-down&content-scaling=fixed&page-id=3397%3A621&starting-point-node-id=3410%3A1307&show-proto-sidebar=1

*Prototype Demo:* INSERIR LINK!!

h2. *11. Teaser*

_Obstech – Tele-CTG_ reimagines how pregnancy monitoring works. Instead of repeated hospital visits for routine CTG exams, pregnant women use a simple wearable device at home, and their clinical team gets the data instantly.

For the pregnant woman: a clear, reassuring app that shows her CTG results in plain language, tracks her pregnancy week by week, and keeps everything in one place: her digital pregnancy booklet.

For the healthcare team: a powerful clinical platform with full CTG traces, patient history, automated reports, and real-time alerts, everything needed to monitor patients remotely without compromising clinical quality.

_Obstech_ is the bridge between the hospital and the home.

h2. *12. Presentation*

The final presentation of _Obstech – Tele-CTG_ will cover the following topics:

+ADICIONAR PONTOS+

h2. *References*

The following scientific articles were reviewed as part of the state-of-the-art analysis: