To solve the disadvantages of traditional fetal monitoring such as time-consuming, cumbersome steps and low coverage, it is paramount to develop remote fetal monitoring. Remote fetal monitoring expands time and space, which is expected to popularize fetal monitoring in remote areas with the low availability of health services. Pregnant women can transmit fetal monitoring data from remote monitoring terminals to the central monitoring station so that doctors can interpret it remotely and detect fetal hypoxia in time. Fetal monitoring involving remote technology has also been carried out, but with some conflicting results.The review aimed to (1) examine the efficacy of remote fetal monitoring in improving maternal-fetal outcomes and (2) identify research gaps in the field to make recommendations for future research.We did a systematic literature search with PubMed, Cochrane Library, Web of Science, Embase, MEDLINE, CINAHL, ProQuest Dissertations and Theses Global, ClinicalTrials.gov, and Open Grey in March 2022. Randomized controlled trials or quasi-experimental trials of remote fetal monitoring were identified. Two reviewers independently searched articles, extracted data, and assessed each study. Primary outcomes (maternal-fetal outcomes) and secondary outcomes (health care usage) were presented as relative risks or mean difference. The review was registered on PROSPERO as CRD42020165038.Of the 9337 retrieved literature, 9 studies were included in the systematic review and meta-analysis (n=1128). Compared with a control group, remote fetal monitoring reduced the risk of neonatal asphyxia (risk ratio 0.66, 95% CI 0.45-0.97; P=.04), with a low heterogeneity of 24%. Other maternal-fetal outcomes did not differ significantly between remote fetal monitoring and routine fetal monitoring, such as cesarean section (P=.21; I2=0%), induced labor (P=.50; I2=0%), instrumental vaginal birth (P=.45; I2=0%), spontaneous delivery (P=.85; I2=0%), gestational weeks at delivery (P=.35; I2=0%), premature delivery (P=.47; I2=0%), and low birth weight (P=.71; I2=0%). Only 2 studies performed a cost analysis, stating that remote fetal monitoring can contribute to reductions in health care costs when compared with conventional care. In addition, remote fetal monitoring might affect the number of visits and duration in the hospital, but it was not possible to draw definite conclusions about the effects due to the limited number of studies.Remote fetal monitoring seems to reduce the incidence of neonatal asphyxia and health care costs compared with routine fetal monitoring. To strengthen the claims on the efficacy of remote fetal monitoring, further well-designed studies are necessary, especially in high-risk pregnant women, such as pregnant women with diabetes, pregnant women with hypertension, and so forth.©Suya Li, Qing Yang, Shuya Niu, Yu Liu. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 22.02.2023.