A systematic review and meta-analysis evaluated teleultrasound in obstetrics to assess feasibility, acceptability, diagnostic accuracy, and cost-effectiveness in prenatal care. Of the 6561 papers screened, 71 studies were included, including 60 clinical observational, five qualitative, four economic and two randomized controlled trials. Image transmission was feasible in both synchronous and asynchronous teleultrasound, with high visualization of the gross structures of the fetus and placenta, but lower in specialized anatomy such as the heart or nervous system. A meta-analysis of 20 anatomical structures showed teleultrasound to be non-inferior to the reference standard with a RR of 1.02 (95% CI [1.00, 1.03]; n=4 studies), a pooled diagnostic accuracy AUC of 0.93 (n=8 studies), a sensitivity of 0.70 (95% CI [0.44, 0.84]), and a low false-positive rate of 0.03 (95% CI [0.01, 0.12]). Acceptability was high among both patients and providers, with evidence of educational and clinical utility particularly in rural areas and low-income countries. The implementation costs are high, but they bring monthly savings. High-quality studies are lacking, which calls for further research with better methodological details.