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Clark JA, Smith LK, Armstrong N. Midwives' and obstetricians' practice, perspectives and experiences in relation to altered fetal movement: A focused ethnographic study. Int J Nurs Stud 2024; 150:104643. [PMID: 38043485 DOI: 10.1016/j.ijnurstu.2023.104643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Reducing avoidable stillbirth is a global priority. The stillbirth rate in England compares unfavourably to that of some other high-income countries. Poorly-managed episodes of altered fetal movement have been highlighted as a key contributor to avoidable stillbirth, and strategies introduced in England in 2016 to reduce perinatal mortality included recommendations for the management of reduced fetal movement. Despite a downward trend in stillbirth rates across the UK, the effects of policies promoting awareness of fetal movement remain uncertain. OBJECTIVE To provide in-depth knowledge of how practice and clinical guidance relating to altered fetal movement are perceived, enacted and experienced by midwives and obstetricians, and explore the relationship between recommended fetal movement care and actual fetal movement care. DESIGN A focused ethnographic approach comprising over 180 h of observation, 15 interviews, and document analysis was used to explore practice at two contrasting UK maternity units. SETTINGS Antenatal services at two UK maternity units, one in the Midlands and one in the North of England. PARTICIPANTS Thirty-six midwives, obstetricians and sonographers and 40 pregnant women participated in the study across 52 observed care episodes and relevant unit activity. Twelve midwives and three obstetricians additionally participated in formal semi-structured interviews. METHODS Fieldnotes, interview transcripts, policy documents, maternity notes and clinical guidelines were analysed using a modified constant comparison method to identify important themes. RESULTS fetal movement practice was mostly consistent and in line with guideline recommendations. Notwithstanding, most midwives and obstetricians had concerns about this area of care, including challenges in diagnosis, conflicting evidence about activity, heightened maternal anxiety, and high rates of monitoring and intervention in otherwise low-risk pregnancies. To address these issues, midwives spent considerable time reassuring women through information and regular monitoring, and coaching them to perceive fetal movement more accurately. CONCLUSIONS Practice relating to altered fetal movement might be more uniform than in the past. However, a heightened focus on fetal movement is associated by some midwives and obstetricians with potential harms, including increased anxiety in pregnancy, and high rates of monitoring and intervention in pregnancies where there are no 'objective concerns'. Challenges in diagnosing a significant change in fetal movement with accuracy might mean that interventions and resources are not being directed towards those pregnancies most at risk. More research is needed to determine how healthcare professionals can engage in conversations about fetal movement and stillbirth to support safe outcomes and positive experiences in pregnancy and birth. REGISTRATION Not registered. TWEETABLE ABSTRACT Midwives and obstetricians take #reducedfetalmovement seriously but worry this 'unreliable' symptom increases anxiety, monitoring and intervention in many 'low risk' pregnancies.
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Affiliation(s)
- Julia A Clark
- Department of Population Health Sciences, University of Leicester, Leicester, UK; School of Health Science, The University of Nottingham, Nottingham, UK.
| | - Lucy K Smith
- Department of Population Health Sciences, University of Leicester, Leicester, UK.
| | - Natalie Armstrong
- Department of Population Health Sciences, University of Leicester, Leicester, UK
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2
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Carroll L, Gallagher L, Smith V. Pregnancy, birth and neonatal outcomes associated with reduced fetal movements: A systematic review and meta-analysis of non-randomised studies. Midwifery 2023; 116:103524. [PMID: 36343466 DOI: 10.1016/j.midw.2022.103524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/27/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
PROBLEM Maternal perception of reduced fetal movements (RFM) is identified as an important alarm signal for possible risk of impending adverse perinatal outcomes. BACKGROUND Perinatal outcomes associated with RFM are increasingly being investigated in non-randomised studies with several associated outcomes, including stillbirth, preterm birth, fetal growth restriction and neonatal death being reported. Findings from studies, however, are conflicting. AIM To synthesise the findings of published studies regarding pregnancy, birth and neonatal outcomes in women who presented with RFM. METHODS PubMed, EMBASE, CINAHL complete, Maternity and Infant Care, PsycINFO, and Science Citation Index databases were searched up to 8th July 2021 and updated again on 8th September 2022. Non-randomised studies involving pregnant women ≥24 weeks' gestation, who presented with a primary complaint of RFM compared to women who did not present with RFM were included. Data were meta-analysed using a random-effects model and presented as Odds Ratios (OR) or Standard Mean Differences (SMD) with 95% Confidence Intervals (CI). FINDINGS Thirty-nine studies were included. Women with RFM had increased odds of stillbirth (OR 3.44, 95% CI 2.02-5.88) and small for gestational age (OR 1.37, 95% CI 1.16-1.61) when compared with women who did not have RFM. Associations were also found for induction of labor, instrumental birth and caesarean section but not for preterm birth (OR 0.92, 95% CI 0.71-1.19) or neonatal death (OR 0.99; 95% CI 0.52-1.90). CONCLUSION This review revealed that RFM is associated with increased odds of stillbirth, small for gestational age, induction of labor, instrumental birth and caesarean section but not preterm birth or neonatal death.
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Affiliation(s)
- Lorraine Carroll
- Assistant Professor in Midwifery, School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland and PhD candidate of School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland.
| | - Louise Gallagher
- Assistant Professor in Midwifery, School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland
| | - Valerie Smith
- Professor in Midwifery, School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland
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O’ Sullivan C, Wilson E, Beckmann M. Five‐year trends in induction of labour in a large Australian metropolitan maternity service. Aust N Z J Obstet Gynaecol 2022; 62:407-412. [DOI: 10.1111/ajo.13486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Caoimhe O’ Sullivan
- Obstetrics & Gynaecology Department Mater Misericordiae Ltd Brisbane Queensland Australia
| | - Erin Wilson
- Obstetrics & Gynaecology Department Mater Misericordiae Ltd Brisbane Queensland Australia
| | - Michael Beckmann
- Obstetrics & Gynaecology Department Mater Misericordiae Ltd Brisbane Queensland Australia
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Flenady V, Gardener G, Ellwood D, Coory M, Weller M, Warrilow KA, Middleton PF, Wojcieszek AM, Groom KM, Boyle FM, East C, Lawford H, Callander E, Said JM, Walker SP, Mahomed K, Andrews C, Gordon A, Norman JE, Crowther C. My Baby's Movements: a stepped-wedge cluster-randomised controlled trial of a fetal movement awareness intervention to reduce stillbirths. BJOG 2021; 129:29-41. [PMID: 34555257 DOI: 10.1111/1471-0528.16944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The My Baby's Movements (MBM) trial aimed to evaluate the impact on stillbirth rates of a multifaceted awareness package (the MBM intervention). DESIGN Stepped-wedge cluster-randomised controlled trial. SETTING Twenty-seven maternity hospitals in Australia and New Zealand. POPULATION Women with a singleton pregnancy without major fetal anomaly at ≥28 weeks of gestation from August 2016 to May 2019. METHODS The MBM intervention was implemented at randomly assigned time points, with the sequential introduction of eight groups of between three and five hospitals at 4-monthly intervals. Using generalised linear mixed models, the stillbirth rate was compared in the control and the intervention periods, adjusting for calendar time, study population characteristics and hospital effects. MAIN OUTCOME MEASURES Stillbirth at ≥28 weeks of gestation. RESULTS There were 304 850 births with 290 105 births meeting the inclusion criteria: 150 053 in the control and 140 052 in the intervention periods. The stillbirth rate was lower (although not statistically significantly so) during the intervention compared with the control period (2.2/1000 versus 2.4/1000 births; aOR 1.18, 95% CI 0.93-1.50; P = 0.18). The decrease in stillbirth rate was greater across calendar time: 2.7/1000 in the first versus 2.0/1000 in the last 18 months. No increase in secondary outcomes, including obstetric intervention or adverse neonatal outcome, was evident. CONCLUSIONS The MBM intervention did not reduce stillbirths beyond the downward trend over time. As a result of low uptake, the role of the intervention remains unclear, although the downward trend across time suggests some benefit in lowering the stillbirth rate. In this study setting, an awareness of the importance of fetal movements may have reached pregnant women and clinicians prior to the implementation of the intervention. TWEETABLE ABSTRACT The My Baby's Movements intervention to raise awareness of decreased fetal movement did not significantly reduce stillbirth rates.
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Affiliation(s)
- V Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - G Gardener
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.,Department of Maternal Fetal Medicine, Mater Misericordiae Limited, Brisbane, Queensland, Australia
| | - D Ellwood
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.,Gold Coast University Hospital, Southport, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - M Coory
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - M Weller
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - K A Warrilow
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - P F Middleton
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.,SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - A M Wojcieszek
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - K M Groom
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - F M Boyle
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.,Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
| | - C East
- Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Hls Lawford
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - E Callander
- Monash University, Melbourne, Victoria, Australia
| | - J M Said
- University of Melbourne, Melbourne, Victoria, Australia.,Sunshine Hospital, Western Health, St Albans, Victoria, Australia
| | - S P Walker
- University of Melbourne, Melbourne, Victoria, Australia
| | - K Mahomed
- Ipswich Hospital, Ipswich, Queensland, Australia
| | - C Andrews
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - A Gordon
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - J E Norman
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - C Crowther
- Liggins Institute, University of Auckland, Auckland, New Zealand
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Ben Zvi D, Gutzeit O, Iluz R, Weissman A, Solt I, Weiner Z, Zipori Y. Optimizing cervical ripening in women presenting with decreased fetal movements. J Matern Fetal Neonatal Med 2021; 35:7417-7421. [PMID: 34278924 DOI: 10.1080/14767058.2021.1949448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the optimal method for cervical ripening in women presenting with decreased fetal movements at term. We hypothesized that women who undergo induction of labor for decreased fetal movements represent a higher risk group, and will benefit from mechanical intervention with cervical ripening balloon rather than with pharmacological prostaglandin E2 vaginal insert. STUDY DESIGN Retrospective cohort study from January 2014 and January 2019. We recommended induction of labor to every woman ≥39 weeks' gestation with complaints of persistent decreased fetal movements. We excluded women with major fetal anomalies, Bishop score of ≥6 on admission, and cases with contraindications to prostaglandins. Women were allocated into one of two groups based on the cervical ripening agent used. In group 1 we introduced the prostaglandin E2 vaginal insert (10 mg dinoprostone in a timed-release formulation). In group 2 we placed the mechanical cervical ripening balloon. The primary outcome of the study, analyzed separately to nulliparous and multiparous women, was the rate of cesarean delivery in each of the groups. RESULTS During the 5-years study, 294 women were included in the final analysis, of which 201 were in the prostaglandin E2 vaginal insert group and 93 were in the cervical ripening balloon group. The rate of cesarean delivery was comparable between the groups (nulliparous: 20.8%, 16/77 versus 21.3%, 10/47. multiparous: 16.9%, 21/124 versus 7%, 3/46, respectively). Other maternal and neonatal secondary outcomes, including the induction-to-delivery time (nulliparous: 32.5 ± 25.3 h versus 26.5 ± 12.2 h. multiparous: 24.6 ± 17.2 h versus 21.25 ± 12.3 h, respectively), were also not different between the two induction methods used. A longer induction-to-delivery time was observed in nulliparous women who had repeat prostaglandin E2 vaginal insert compared with the cervical ripening balloon group (74.6 ± 27.3 h versus 26.5 ± 12.2 h, p < .01). CONCLUSION Both pharmacological and mechanical methods can safely and efficiently be used for cervical ripening in women presenting with decreased fetal movements at term. With repeat prostaglandin E2 use, nulliparous women may experience a prolong labor compared with the cervical ripening balloon group, but maternal or fetal safety are not compromised.
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Affiliation(s)
- Dikla Ben Zvi
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Ola Gutzeit
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Roee Iluz
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Amir Weissman
- High-Risk Pregnancy Unit, Lin Medical Center, Clalit Health Services, Haifa, Israel
| | - Ido Solt
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.,Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.,Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Yaniv Zipori
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
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Interventions relating to fetal movements for improving pregnancy outcomes. Hippokratia 2021. [DOI: 10.1002/14651858.cd014714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Chan L, Gordon A, Warrilow K, Wojcieszek A, Firth T, Loxton F, Bauman A, Flenady V. Evaluation of Movements Matter: A social media and hospital-based campaign aimed at raising awareness of decreased fetal movements. Aust N Z J Obstet Gynaecol 2021; 61:846-854. [PMID: 33908059 DOI: 10.1111/ajo.13360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/24/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Movements Matter campaign aimed to raise awareness of decreased fetal movements (DFM) among pregnant women and inform clinicians of best practice management. AIM To conduct a process evaluation of campaign implementation, and an impact evaluation of the campaign's effects on knowledge and experiences of pregnant women, and attitudes and practices of clinicians in relation to DFM. METHODS This study used a cross-sectional before-after design. Pregnant women and clinicians were sampled at five hospitals. Women were surveyed about their knowledge of DFM, and actions to take if they noticed DFM. Clinicians were asked about their current practices and attitudes about informing women about DFM. Logistic regression was used to calculate campaign effects on outcome measures. RESULTS The Movements Matter campaign reached 653 262 people on social media, as well as being covered on news media and popular women's websites. The evaluation surveyed 1142 pregnant women pre-campaign and 473 post-campaign, and 372 clinicians pre-campaign and 149 post-campaign. Following the campaign, women were more likely to be aware that babies should move the same amount in late pregnancy (adjusted odds ratio (aOR) 1.81, 95% CI 1.43-2.27), and were more likely to contact their health service immediately if their baby was moving less (aOR 1.52, 95% CI 1.22-1.91). Clinicians were 2.84 times more likely to recommend women should come in for assessment if they experience DFM (95% CI 1.35-5.97). CONCLUSIONS This evaluation has shown that a campaign using social media and in-hospital education materials led to some increases in knowledge about fetal movements among pregnant women.
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Affiliation(s)
- Lilian Chan
- Prevention Research Collaboration, Sydney School of Public Health and Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Adrienne Gordon
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Kara Warrilow
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Aleena Wojcieszek
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Tracy Firth
- Maternity and Newborn Clinical Network, Safer Care Victoria, Melbourne, Victoria, Australia
| | - Felicity Loxton
- Centres of Clinical Excellence, Safer Care Victoria, Melbourne, Victoria, Australia
| | - Adrian Bauman
- Prevention Research Collaboration, Sydney School of Public Health and Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Vicki Flenady
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
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Akselsson A, Lindgren H, Georgsson S, Pettersson K, Steineck G, Skokic V, Rådestad I. Mindfetalness to increase women's awareness of fetal movements and pregnancy outcomes: a cluster-randomised controlled trial including 39 865 women. BJOG 2020; 127:829-837. [PMID: 31971325 DOI: 10.1111/1471-0528.16104] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine whether a method for raising women's awareness of fetal movements, Mindfetalness, can affect pregnancy outcomes. DESIGN Cluster-randomised controlled trial. SETTING Sixty-seven maternity clinics in Stockholm, Sweden. POPULATION Women with singleton pregnancy with birth from 32 weeks' gestation. METHODS Women registered at a clinic randomised to Mindfetalness were assigned to receive a leaflet about Mindfetalness (n = 19 639) in comparison with routine care (n = 20 226). Data were collected from a population-based register. MAIN OUTCOME MEASURES Apgar score <7 at 5 minutes after birth, visit to healthcare due to decrease in fetal movements. Other outcomes: Apgar score <4 at 5 minutes after birth, small-for-gestational-age and mode of delivery. RESULTS No difference (1.1 versus 1.1%, relative risk [RR] 1.0; 95% CI 0.8-1.2) was found between the Mindfetalness group and the Routine care group for a 5-minute Apgar score <7. Women in the Mindfetalness group contacted healthcare more often due to decreased fetal movements (6.6 versus 3.8%, RR 1.72; 95% CI 1.57-1.87). Mindfetalness was associated with a reduction of babies born small-for-gestational-age (RR 0.95, 95% CI 0.90-1.00), babies born after gestational week 41+6 (RR 0.91, 95% CI 0.83-0.98) and caesarean sections (19.0 versus 20.0%, RR 0.95; 95% CI 0.91-0.99). CONCLUSIONS Mindfetalness did not reduce the number of babies born with an Apgar score <7. However, Mindfetalness was associated with the health benefits of decreased incidence of caesarean section and fewer children born small-for-gestational-age. TWEETABLE ABSTRACT Introducing Mindfetalness in maternity care decreased caesarean sections but had no effect on the occurrence of Apgar scores <7.
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Affiliation(s)
- A Akselsson
- Department of Women and Children's Health, Karolinska Institutet, Sophiahemmet University, Stockholm, Sweden
| | - H Lindgren
- Department of Women and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - S Georgsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, The Swedish Red Cross University College, Stockholm, Sweden
| | - K Pettersson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - G Steineck
- Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - V Skokic
- Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - I Rådestad
- Sophiahemmet University, Stockholm, Sweden
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9
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Gardener G, Weller M, Ellwood D, Flenady V. Decreased fetal movements (DFM) - finding the balance. Aust N Z J Obstet Gynaecol 2019; 59:E14. [PMID: 31368514 DOI: 10.1111/ajo.13024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Glenn Gardener
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia
| | - Megan Weller
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia
| | - David Ellwood
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia
| | - Vicki Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia
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10
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Flenady V, Gardener G, Boyle FM, Callander E, Coory M, East C, Ellwood D, Gordon A, Groom KM, Middleton PF, Norman JE, Warrilow KA, Weller M, Wojcieszek AM, Crowther C. My Baby's Movements: a stepped wedge cluster randomised controlled trial to raise maternal awareness of fetal movements during pregnancy study protocol. BMC Pregnancy Childbirth 2019; 19:430. [PMID: 31752771 PMCID: PMC6873438 DOI: 10.1186/s12884-019-2575-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/31/2019] [Indexed: 12/02/2022] Open
Abstract
Background Stillbirth is a devastating pregnancy outcome that has a profound and lasting impact on women and families. Globally, there are over 2.6 million stillbirths annually and progress in reducing these deaths has been slow. Maternal perception of decreased fetal movements (DFM) is strongly associated with stillbirth. However, maternal awareness of DFM and clinical management of women reporting DFM is often suboptimal. The My Baby’s Movements trial aims to evaluate an intervention package for maternity services including a mobile phone application for women and clinician education (MBM intervention) in reducing late gestation stillbirth rates. Methods/design This is a stepped wedge cluster randomised controlled trial with sequential introduction of the MBM intervention to 8 groups of 3–5 hospitals at four-monthly intervals over 3 years. The target population is women with a singleton pregnancy, without lethal fetal abnormality, attending for antenatal care and clinicians providing maternity care at 26 maternity services in Australia and New Zealand. The primary outcome is stillbirth from 28 weeks’ gestation. Secondary outcomes address: a) neonatal morbidity and mortality; b) maternal psychosocial outcomes and health-seeking behaviour; c) health services utilisation; d) women’s and clinicians’ knowledge of fetal movements; and e) cost. 256,700 births (average of 3170 per hospital) will detect a 30% reduction in stillbirth rates from 3/1000 births to 2/1000 births, assuming a significance level of 5%. Analysis will utilise generalised linear mixed models. Discussion Maternal perception of DFM is a marker of an at-risk pregnancy and commonly precedes a stillbirth. MBM offers a simple, inexpensive resource to reduce the number of stillborn babies, and families suffering the distressing consequences of such a loss. This large pragmatic trial will provide evidence on benefits and potential harms of raising awareness of DFM using a mobile phone app. Trial registration ACTRN12614000291684. Registered 19 March 2014. Version Protocol Version 6.1, February 2018.
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Affiliation(s)
- V Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Level 3 Aubigny Place Mater Research, South Brisbane QLD, Brisbane, 4101, Australia.
| | - G Gardener
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Level 3 Aubigny Place Mater Research, South Brisbane QLD, Brisbane, 4101, Australia.,Department of Maternal Fetal Medicine, Mater Misericordiae Limited, Brisbane, Australia
| | - F M Boyle
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Level 3 Aubigny Place Mater Research, South Brisbane QLD, Brisbane, 4101, Australia.,Institute for Social Science Research, The University of Queensland, Brisbane, Australia
| | - E Callander
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Level 3 Aubigny Place Mater Research, South Brisbane QLD, Brisbane, 4101, Australia.,School of Medicine, Griffith University, Gold Coast, Australia
| | - M Coory
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Level 3 Aubigny Place Mater Research, South Brisbane QLD, Brisbane, 4101, Australia
| | - C East
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Level 3 Aubigny Place Mater Research, South Brisbane QLD, Brisbane, 4101, Australia.,School of Nursing and Midwifery, Monash University and Monash Women's Maternity Services, Clayton, Victoria, Australia.,School of Nursing & Midwifery, La Trobe University, Melbourne, Brazil
| | - D Ellwood
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Level 3 Aubigny Place Mater Research, South Brisbane QLD, Brisbane, 4101, Australia.,School of Medicine, Griffith University, Gold Coast, Australia.,Gold Coast University Hospital, Southport, Australia
| | - A Gordon
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Level 3 Aubigny Place Mater Research, South Brisbane QLD, Brisbane, 4101, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - K M Groom
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - P F Middleton
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Level 3 Aubigny Place Mater Research, South Brisbane QLD, Brisbane, 4101, Australia.,SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - J E Norman
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - K A Warrilow
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Level 3 Aubigny Place Mater Research, South Brisbane QLD, Brisbane, 4101, Australia
| | - M Weller
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Level 3 Aubigny Place Mater Research, South Brisbane QLD, Brisbane, 4101, Australia
| | - A M Wojcieszek
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Level 3 Aubigny Place Mater Research, South Brisbane QLD, Brisbane, 4101, Australia
| | - C Crowther
- Liggins Institute, University of Auckland, Auckland, New Zealand
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11
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Carroll L, Gallagher L, Smith V. Risk factors for reduced fetal movements in pregnancy: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2019; 243:72-82. [PMID: 31677496 DOI: 10.1016/j.ejogrb.2019.09.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/26/2019] [Accepted: 09/30/2019] [Indexed: 10/25/2022]
Abstract
Maternal perception of reduced fetal movements (RFM) is an important clinical marker to identify women at higher risk of adverse perinatal outcomes. Preventing and reducing stillbirths can only be achieved through better detection and management of women with RFM, however the characteristics of women who present with RFM in pregnancy vary. A systematic review was conducted to explore the risk factors associated with reduced fetal movements (RFM) in pregnancy. PubMed, EMBASE, CINAHL, Maternity and Infant Care, PsycINFO and Science Citation Index were searched, from their inception date, for studies published up to 16th May 2019. Non-randomised observational studies reporting risk factors in pregnant women presenting with a primary complaint of RFM during pregnancy were included. The quality of the included studies was assessed with the Quality in Prognosis Studies (QUIPS) tool. Meta-analyses were performed using RevMan 5.3 software for each identified risk factor where two or more studies reported on the same risk factor. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Twenty-seven studies reporting on risk factors for RFM during pregnancy were included. Women presenting with RFM during pregnancy are more likely to be Caucasian, smokers, and have an anterior placenta, oligohydramnios and polyhydramnios. No difference was found in parity or the mean age of women presenting with RFM and women who did not present with RFM. Previous caesarean section, postdates >42 weeks', and other medical conditions, including diabetes and hypertensive disorders were not predictive for RFM during pregnancy. Modifiable and non-modifiable risk factors associated with RFM in pregnancy were identified. These results can be used to raise awareness of factors associated with RFM, and prompt women to attend their maternity care provider should concerns arise.
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Affiliation(s)
- Lorraine Carroll
- School of Nursing and Midwifery, Trinity College Dublin, Ireland; School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland.
| | - Louise Gallagher
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Valerie Smith
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
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Andrews CJ, Ellwood D, Middleton PF, Homer CSE, Reinebrant HE, Donnolley N, Boyle FM, Gordon A, Nicholl M, Morris J, Gardener G, Davies-Tuck M, Wallace EM, Flenady VJ. Survey of Australian maternity hospitals to inform development and implementation of a stillbirth prevention 'bundle of care'. Women Birth 2019; 33:251-258. [PMID: 31227443 DOI: 10.1016/j.wombi.2019.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/31/2019] [Accepted: 06/02/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND 'Bundles of care' are being implemented to improve key practice gaps in perinatal care. As part of our development of a stillbirth prevention bundle, we consulted with Australian maternity care providers. OBJECTIVE To gain the insights of Australian maternity care providers to inform the development and implementation of a bundle of care for stillbirth prevention. METHODS A 2018 on-line survey of hospitals providing maternity services included 55 questions incorporating multiple choice, Likert items and open text. A senior clinician at each site completed the survey. The survey asked questions about practices related to fetal growth restriction, decreased fetal movements, smoking cessation, intrapartum fetal monitoring, maternal sleep position and perinatal mortality audit. The objectives were to assess which elements of care were most valued; best practice frequency; and, barriers and enablers to implementation. RESULTS 227 hospitals were invited with 83 (37%) responding. All proposed elements were perceived as important. Hospitals were least likely to follow best practice recommendations "all the time" for smoking cessation support (<50%), risk assessment for fetal growth restriction (<40%) and advice on sleep position (<20%). Time constraints, absence of clear guidelines and lack of continuity of carer were recognised as barriers to implementation across care practices. CONCLUSIONS Areas for practice improvement were evident. All elements of care were valued, with increasing awareness of safe sleeping position perceived as less important. There is strong support from maternity care providers across Australia for a bundle of care to reduce stillbirth.
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Affiliation(s)
- C J Andrews
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia.
| | - D Ellwood
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia; Gold Coast University Hospital, Griffith University, Gold Coast, Australia
| | - P F Middleton
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia; SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - C S E Homer
- Burnet Institute, Melbourne, Victoria, Australia
| | - H E Reinebrant
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia
| | - N Donnolley
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - F M Boyle
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia; Institute for Social Science Research, The University of Queensland, Brisbane, Australia
| | - A Gordon
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia; Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - M Nicholl
- University of Sydney, Sydney, NSW, Australia
| | - J Morris
- Kolling Institute of Medical Research, University of Sydney, NSW, Australia
| | - G Gardener
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia
| | - M Davies-Tuck
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Victoria, Australia; Safer Care Victoria, Department of Health and Human Services, Melbourne, Victoria, Australia
| | - E M Wallace
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Victoria, Australia; Safer Care Victoria, Department of Health and Human Services, Melbourne, Victoria, Australia
| | - V J Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia
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Higgins LE, Myers JE, Sibley CP, Johnstone ED, Heazell AEP. Antenatal placental assessment in the prediction of adverse pregnancy outcome after reduced fetal movement. PLoS One 2018; 13:e0206533. [PMID: 30395584 PMCID: PMC6218043 DOI: 10.1371/journal.pone.0206533] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 10/15/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To assess the value of in utero placental assessment in predicting adverse pregnancy outcome after reported reduced fetal movements (RFM). METHOD A non-interventional prospective cohort study of women (N = 300) with subjective RFM at ≥28 weeks' gestation in singleton non-anomalous pregnancies at a UK tertiary maternity hospital. Clinical, sonographic (fetal weight, placental size and maternal, fetal and placental arterial Doppler) and biochemical (maternal serum hCG, hPL, progesterone, PlGF and sFlt-1) assessment was conducted. Multiple logistic regression identified combinations of measurements (models) most predictive of adverse pregnancy outcome (perinatal mortality, birth weight <10th centile, five minute Apgar score <7, umbilical arterial pH <7.1 or base excess <-10, neonatal intensive care admission). Models were compared by test performance characteristics (ROC curve, sensitivity, specificity, positive/negative predictive value, positive/negative likelihood ratios) against baseline care (estimated fetal weight centile, amniotic fluid index and gestation at presentation). RESULTS 61 (20.6%) pregnancies ended in adverse outcome. Models incorporating PlGF/sFlt-1 ratio and umbilical artery free loop Doppler impedance demonstrated modest improvement in ROC area for adverse outcome (baseline care 0.69 vs. proposed models 0.73-0.76, p<0.05). However, there was little improvement in other test characteristics (baseline vs. best proposed model: sensitivity 21.7% [95% confidence interval 13.1-33.6] vs. 35.8%% [24.4-49.3], specificity 96.6% [93.4-98.3] vs. 94.7% [90.7-97.0], PPV 61.9% [40.9-79.3] vs. 63.3% [45.5-78.1], NPV 82.8% [77.9-86.8] vs. 85.2% [80.0-89.2], positive LR 6.3 [2.8-14.6] vs. 6.7 [3.4-3.3], negative LR 0.81 [0.71-0.93] vs. 0.68 [0.55-0.83]) and wide confidence intervals. Negative post-test probability remained high (16.7% vs. 14.0%). CONCLUSION Antenatal placental assessment may improve identification of RFM pregnancies at highest risk of adverse pregnancy outcome but further work is required to understand and refine currently available outcome definitions and diagnostic techniques to improve clinical utility.
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Affiliation(s)
- Lucy E. Higgins
- Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- St. Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Jenny E. Myers
- Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- St. Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Colin P. Sibley
- Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- St. Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Edward D. Johnstone
- Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- St. Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Alexander E. P. Heazell
- Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- St. Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
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Armstrong-Buisseret L, Mitchell E, Hepburn T, Duley L, Thornton JG, Roberts TE, Storey C, Smyth R, Heazell AEP. Reduced fetal movement intervention Trial-2 (ReMIT-2): protocol for a pilot randomised controlled trial of standard care informed by the result of a placental growth factor (PlGF) blood test versus standard care alone in women presenting with reduced fetal movement at or after 36 + 0 weeks gestation. Trials 2018; 19:531. [PMID: 30285835 PMCID: PMC6167841 DOI: 10.1186/s13063-018-2859-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 08/13/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Forty percent of babies who are stillborn born die after 36 weeks gestation and have no lethal structural abnormality. Maternal perception of reduced fetal movement (RFM) is associated with stillbirth and is related to abnormal placental structure and function. The ultimate objective of this trial is to assess whether for women with RFM, intervention directed by measurement of placental biochemical factors in addition to standard care improves pregnancy outcome compared with standard care alone. This is the protocol for a pilot trial to determine the feasibility of a definitive trial and also provide proof of concept that informing care by measurement of placental factors improves neonatal outcomes. METHODS ReMIT-2 is a multicentre, pilot randomised controlled trial of care informed by results of an additional placental factor blood test versus standard care alone for women presenting with RFM at or after 36+ 0 weeks gestation. Participants will be randomised 1:1 to the intervention arm where the blood test result is revealed and acted on, or to the control arm where the blood sample is not tested immediately and therefore the result cannot be acted on. All participants will be followed up six weeks after delivery to assess their health status and views of the trial, along with healthcare costs. A sub-group will be interviewed within 16 weeks after delivery to further explore their views of the trial. Outcomes to determine feasibility of a definitive trial include number of potentially eligible women, proportion lost to follow-up, clinical characteristics at randomisation, reasons for non-recruitment, compliance with the trial intervention and views of participants and clinicians about the trial. Proof of concept outcomes include: rates of induction of labour; Caesarean birth; and a composite neonatal outcome of stillbirths and deaths before discharge, 5-min Apgar score < 7, umbilical artery pH < 7.05 and admission to neonatal unit for > 48 h. DISCUSSION Results from this pilot trial will help determine whether a large definitive trial is feasible. Such a study would provide evidence to guide management of women with RFM and reduce stillbirths. TRIAL REGISTRATION ISRCTN Registry, ISRCTN12067514 . Registered on 8 September 2017.
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Affiliation(s)
- Lindsay Armstrong-Buisseret
- Nottingham Clinical Trials Unit (NCTU), University of Nottingham, NHSP, C Floor, South Block, Queens Medical Centre, Nottingham, NG7 2UH UK
| | - Eleanor Mitchell
- Nottingham Clinical Trials Unit (NCTU), University of Nottingham, NHSP, C Floor, South Block, Queens Medical Centre, Nottingham, NG7 2UH UK
| | - Trish Hepburn
- Nottingham Clinical Trials Unit (NCTU), University of Nottingham, NHSP, C Floor, South Block, Queens Medical Centre, Nottingham, NG7 2UH UK
| | - Lelia Duley
- Nottingham Clinical Trials Unit (NCTU), University of Nottingham, NHSP, C Floor, South Block, Queens Medical Centre, Nottingham, NG7 2UH UK
| | - Jim G. Thornton
- Nottingham Clinical Trials Unit (NCTU), University of Nottingham, NHSP, C Floor, South Block, Queens Medical Centre, Nottingham, NG7 2UH UK
| | - Tracy E. Roberts
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Claire Storey
- International Stillbirth Alliance, c/o Maternal and Fetal Health Research Centre, 5th Floor (Research), St Mary’s Hospital, Oxford Road, Manchester, M13 9WL UK
| | - Rebecca Smyth
- School of Nursing, Midwifery and Social Work, Room 4. 329, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Alexander E. P. Heazell
- Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, Manchester, M13 9WL UK
- St. Mary’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL UK
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15
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Heazell AEP, Budd J, Li M, Cronin R, Bradford B, McCowan LME, Mitchell EA, Stacey T, Martin B, Roberts D, Thompson JMD. Alterations in maternally perceived fetal movement and their association with late stillbirth: findings from the Midland and North of England stillbirth case-control study. BMJ Open 2018; 8:e020031. [PMID: 29982198 PMCID: PMC6042603 DOI: 10.1136/bmjopen-2017-020031] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To report perception of fetal movements in women who experienced a stillbirth compared with controls at a similar gestation with a live birth. DESIGN Case-control study. SETTING 41 maternity units in the UK. PARTICIPANTS Cases were women who had a late stillbirth ≥28 weeks gestation (n=291) and controls were women with an ongoing pregnancy at the time of the interview (n=733). Controls were frequency matched to cases by obstetric unit and gestational age. METHODS Data were collected using an interviewer-administered questionnaire which included questions on maternal perception of fetal movement (frequency, strength, increased and decreased movements and hiccups) in the 2 weeks before the interview/stillbirth. Five fetal movement patterns were identified incorporating the changes in strength and frequency in the last 2 weeks by combining groups of similar pattern and risk. Multivariable analysis adjusted for known confounders. PRIMARY OUTCOME MEASURE Association of maternally perceived fetal movements in relation to late stillbirth. RESULTS In multivariable analyses, women who reported increased strength of movements in the last 2 weeks had decreased risk of late stillbirth compared with those whose movements were unchanged (adjusted OR (aOR) 0.18, 95% CI 0.13 to 0.26). Women with decreased frequency (without increase in strength) of fetal movements were at increased risk (aOR 4.51, 95% CI 2.38 to 8.55). Daily perception of fetal hiccups was protective (aOR 0.31, 95% CI 0.17 to 0.56). CONCLUSIONS Increased strength of fetal movements and fetal hiccups is associated with decreased risk of stillbirth. Alterations in frequency of fetal movements are important in identifying pregnancies at increased risk of stillbirth, with the greatest risk in women noting a reduction in fetal activity. Clinical guidance should be updated to reflect that increase in strength and frequency of fetal movements is associated with the lowest risk of stillbirth, and that decreased fetal movements are associated with stillbirth. TRIAL REGISTRATION NUMBER NCT02025530.
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Affiliation(s)
- Alexander E P Heazell
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biological, Medical and Human Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Jayne Budd
- Manchester Academic Health Science Centre, St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Minglan Li
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Robin Cronin
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Billie Bradford
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | | | - Edwin A Mitchell
- Department of Paediatrics, Child Health and Youth Health, University of Auckland, Auckland, New Zealand
| | | | - Bill Martin
- Department of Obstetrics, Birmingham Women's Hospital NHS Foundation Trust, Birmingham, UK
| | - Devender Roberts
- Department of Obstetrics, Liverpool Women's NHS Foundation Trust, Liverpool, Liverpool, UK
- Department of Obstetrics and Gynaecology, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - John M D Thompson
- Department of Paediatrics, Child Health and Youth Health, University of Auckland, Auckland, New Zealand
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Daly LM, Gardener G, Bowring V, Burton W, Chadha Y, Ellwood D, Frøen F, Gordon A, Heazell A, Mahomed K, McDonald S, Norman JE, Oats J, Flenady V. Care of pregnant women with decreased fetal movements: Update of a clinical practice guideline for Australia and New Zealand. Aust N Z J Obstet Gynaecol 2018; 58:463-468. [DOI: 10.1111/ajo.12762] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 11/22/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Lisa M. Daly
- NHMRC Centre of Research Excellence in Stillbirth; Mater Research Institute,; The University of Queensland; Brisbane Australia
| | - Glenn Gardener
- Mater Health Services; The University of Queensland; Brisbane Australia
| | | | - Wendy Burton
- Morningside General Practice; Brisbane Australia
| | - Yogesh Chadha
- Royal Brisbane and Women's Hospital; Brisbane Australia
| | - David Ellwood
- Gold Coast University Hospital; Griffith University; Gold Coast Australia
| | | | - Adrienne Gordon
- Royal Prince Alfred Hospital; University of Sydney; Sydney Australia
| | - Alexander Heazell
- Maternal and Fetal Health Research Centre,; Faculty of Biology, Medicine and Health; University of Manchester; Manchester UK
| | - Kassam Mahomed
- Ipswich Hospital; The University of Queensland; Ipswich Australia
| | - Susan McDonald
- La Trobe University and Mercy Hospital for Women; Melbourne Australia
| | | | - Jeremy Oats
- Melbourne School of Population and Global Health; University of Melbourne; Melbourne Australia
| | - Vicki Flenady
- NHMRC Centre of Research Excellence in Stillbirth; Mater Research Institute,; The University of Queensland; Brisbane Australia
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17
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Smyth RMD, Taylor W, Heazell AE, Furber C, Whitworth M, Lavender T. Women's and clinicians perspectives of presentation with reduced fetal movements: a qualitative study. BMC Pregnancy Childbirth 2016; 16:280. [PMID: 27671523 PMCID: PMC5037887 DOI: 10.1186/s12884-016-1074-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 09/07/2016] [Indexed: 11/29/2022] Open
Abstract
Background Worldwide maternal perception of fetal movements has been used for many years to evaluate fetal wellbeing. It is intuitively regarded as an expression of fetal well-being as pregnancies in which women consistently report regular fetal movements have very low morbidity and mortality. Conversely, maternal perception of reduced fetal movements is associated with adverse pregnancy outcomes. We sought to gain insight into pregnant women’s and clinicians views and experiences of reduced movements. Method We performed qualitative semi-structured interviews with pregnant women who experienced reduced fetal movements in their current pregnancy and health professionals who provide maternity care. Our aim was to develop a better understanding of events, facilitators and barriers to presentation with reduced fetal movements. Data analysis was conducted using framework analysis principles. Results Twenty-one women and 10 clinicians were interviewed. The themes that emerged following the final coding were influences of social network, facilitators and barriers to presentation and the desire for normality. Conclusions This study aids understanding about why women present with reduced movements and how they reach the decision to attend hospital. This should inform professionals’ views and practice, such that appreciating and addressing women’s concerns may reduce anxiety and make presentation with further reduced movements more likely, which is desirable as this group is at increased risk of adverse outcome. To address problems with information about normal and abnormal fetal movements, high-quality information is needed that is accessible to women and their families.
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Affiliation(s)
- R M D Smyth
- Division of Nursing Midwifery and Social Work, University of Manchester, Manchester, M13 9PL, UK.
| | - W Taylor
- Maternal and Fetal Health Research Centre 5th Floor (Research) St Mary's Hospital Central Manchester NHS Foundation Trust, St Mary's Hospital, Manchester, M13 9WL, UK
| | - A E Heazell
- Maternal and Fetal Health Research Centre 5th Floor (Research) St Mary's Hospital Central Manchester NHS Foundation Trust, St Mary's Hospital, Manchester, M13 9WL, UK
| | - C Furber
- Division of Nursing Midwifery and Social Work, University of Manchester, Manchester, M13 9PL, UK
| | - M Whitworth
- Maternal and Fetal Health Research Centre 5th Floor (Research) St Mary's Hospital Central Manchester NHS Foundation Trust, St Mary's Hospital, Manchester, M13 9WL, UK
| | - T Lavender
- Division of Nursing Midwifery and Social Work, University of Manchester, Manchester, M13 9PL, UK
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18
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Georgsson S, Linde A, Pettersson K, Nilsson R, Rådestad I. To be taken seriously and receive rapid and adequate care - Womens' requests when they consult health care for reduced fetal movements. Midwifery 2016; 40:102-8. [PMID: 27428105 DOI: 10.1016/j.midw.2016.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/09/2016] [Accepted: 06/06/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND decreased fetal movement is a reason for women to seek health care in late pregnancy. OBJECTIVE to examine what pregnant women who present with decreased fetal movements want to communicate to health care professionals and to other women in the same situation. DESIGN a qualitative descriptive study. SETTING AND PARTICIPANTS questionnaires were distributed in all seven labour wards in Stockholm from 1 January to 31 December 2014 to women who consulted care due to decreased fetal movements. In total, 3555 questionnaires were completed of which 1 000 were included in this study. The women's responses to the open ended question: "Is there something you want to communicate to health care professionals who take care of women with decreased fetal movement or to women who experience decreased fetal movements?", were analysed with manifest content analysis. FINDING three categories were revealed about requests to health care professionals: Pay attention to the woman and take her seriously, Rapid and adequate care and Improved information on fetal movements. Regarding what the women want to communicate to other pregnant women, four categories were revealed: Contact health care for check-up, Pay attention to fetal movement, Recommended source of information and Practical advice. CONCLUSION pregnant women who consult health care due to decreased fetal movements want to be taken seriously and receive rapid and adequate care with the health of the infant as the primary priority. The women requested uniform information about decreased fetal movements. They wished to convey to others in the same situation the importance of consulting care once too often rather than one time too few.
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Affiliation(s)
- Susanne Georgsson
- Sophiahemmet University, Box 5605, SE-114 86 Stockholm, Sweden; Department of Clinical Science, Intervention and Technology, Karolinska Institutet, SE 171 77 Stockholm, Sweden.
| | - Anders Linde
- Sophiahemmet University, Box 5605, SE-114 86 Stockholm, Sweden; Department of Clinical Science, Intervention and Technology, Karolinska Institutet, SE 171 77 Stockholm, Sweden.
| | - Karin Pettersson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, SE 171 77 Stockholm, Sweden.
| | - Rebecca Nilsson
- Sophiahemmet University, Box 5605, SE-114 86 Stockholm, Sweden.
| | - Ingela Rådestad
- Sophiahemmet University, Box 5605, SE-114 86 Stockholm, Sweden.
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Scala C, Bhide A, Familiari A, Pagani G, Khalil A, Papageorghiou A, Thilaganathan B. Number of episodes of reduced fetal movement at term: association with adverse perinatal outcome. Am J Obstet Gynecol 2015. [PMID: 26205461 DOI: 10.1016/j.ajog.2015.07.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aims of this study were evaluation of the association of reduced fetal movements (RFM) and small-for-gestational-age (SGA) birth at term and to explore if fetal and maternal outcomes are different with single vs repeated episodes of RFM and normal fetal assessment test results. STUDY DESIGN This was a retrospective cohort study of all singleton pregnancies referred for RFMs at a tertiary fetal medicine unit from January 2008 through September 2014. Ultrasound and Doppler indices were obtained from a computerized ultrasound database and pregnancy outcome was collected from hospital records. RESULTS Of the 21,944 women with a singleton pregnancy booked for maternity care during the study period, 1234 women (5.62%) reported RFMs >36+0 weeks. Of these, 1029 women (83.4%) reported a single episode of RFM and 205 (16.6%) had ≥2 presentations for RFM. Women with repeated RFMs had a significantly higher mean uterine artery pulsatility index in the second trimester. The prevalence of SGA baby at birth in women presenting with a single episode as compared to repeated episodes of RFM was 9.8% and 44.2%, respectively (odds ratio, 7.3; 95% confidence interval, 5.1-10.4; P < .05). CONCLUSION Repeated episodes of RFMs at term are more likely to occur in women with high second-trimester uterine artery Doppler resistance indices and are strongly associated with the birth of SGA infants. Women presenting with repeated episodes of RFM should be treated as being at high risk of placental dysfunction irrespective of the results of prenatal ultrasound and Doppler assessment.
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Affiliation(s)
- Carolina Scala
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, United Kingdom.
| | - Amar Bhide
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, United Kingdom
| | - Alessandra Familiari
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, United Kingdom
| | - Giorgio Pagani
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, United Kingdom
| | - Asma Khalil
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, United Kingdom
| | - Aris Papageorghiou
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, United Kingdom
| | - Basky Thilaganathan
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, United Kingdom
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Warland J, O'Brien LM, Heazell AEP, Mitchell EA. An international internet survey of the experiences of 1,714 mothers with a late stillbirth: the STARS cohort study. BMC Pregnancy Childbirth 2015; 15:172. [PMID: 26276347 PMCID: PMC4537542 DOI: 10.1186/s12884-015-0602-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 07/28/2015] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Stillbirth occurring after 28 weeks gestation affects between 1.5-4.5 per 1,000 births in high-income countries. The majority of stillbirths in this setting occur in women without risk factors. In addition, many established risk factors such as nulliparity and maternal age are not amenable to modification during pregnancy. Identification of other risk factors which could be amenable to change in pregnancy should be a priority in stillbirth prevention research. Therefore, this study aimed to utilise an online survey asking women who had a stillbirth about their pregnancy in order to identify any common symptoms and experiences. METHODS A web-based survey. RESULTS A total of 1,714 women who had experienced a stillbirth >3 weeks prior to enrolment completed the survey. Common experiences identified were: perception of changes in fetal movement (63% of respondents), reports of a "gut instinct" that something was wrong (68%), and perceived time of death occurring overnight (56%). A quarter of participants believed that their baby's death was due to a cord issue and another 18% indicated that they did not know the reason why their baby died. In many cases (55%) the mother believed the cause of death was different to that told by clinicians. CONCLUSIONS This study confirms the association between altered fetal movements and stillbirth and highlights novel associations that merit closer scrutiny including a maternal gut instinct that something was wrong. The potential importance of maternal sleep is highlighted by the finding of more than half the mothers believing their baby died during the night. This study supports the importance of listening to mothers' concerns and symptoms during pregnancy and highlights the need for thorough investigation of stillbirth and appropriate explanation being given to parents.
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Affiliation(s)
- Jane Warland
- Mothers, Babies and Families: Health Research Group, School of Nursing and Midwifery University of South Australia, Adelaide, SA, Australia.
| | - Louise M O'Brien
- Sleep Disorders Center, Department of Neurology, Department of Obstetrics and Gynecology, and Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI, USA.
| | - Alexander E P Heazell
- Maternal and Fetal Health Research Centre, University of Manchester, Manchester, UK.
| | - Edwin A Mitchell
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.
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Mohr Sasson A, Tsur A, Kalter A, Weissmann Brenner A, Gindes L, Weisz B. Reduced fetal movement: factors affecting maternal perception. J Matern Fetal Neonatal Med 2015; 29:1318-21. [DOI: 10.3109/14767058.2015.1047335] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Higgins LE, Rey de Castro N, Addo N, Wareing M, Greenwood SL, Jones RL, Sibley CP, Johnstone ED, Heazell AEP. Placental Features of Late-Onset Adverse Pregnancy Outcome. PLoS One 2015; 10:e0129117. [PMID: 26120838 PMCID: PMC4488264 DOI: 10.1371/journal.pone.0129117] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 05/05/2015] [Indexed: 12/12/2022] Open
Abstract
Objective Currently, no investigations reliably identify placental dysfunction in late pregnancy. To facilitate the development of such investigations we aimed to identify placental features that differ between normal and adverse outcome in late pregnancy in a group of pregnancies with reduced fetal movement. Methods Following third trimester presentation with reduced fetal movement (N = 100), placental structure ex vivo was measured. Placental function was then assessed in terms of (i) chorionic plate artery agonist responses and length-tension characteristics using wire myography and (ii) production and release of placentally derived hormones (by quantitative polymerase chain reaction and enzyme linked immunosorbant assay of villous tissue and explant conditioned culture medium). Results Placentas from pregnancies ending in adverse outcome (N = 23) were ~25% smaller in weight, volume, length, width and disc area (all p<0.0001) compared with those from normal outcome pregnancies. Villous and trophoblast areas were unchanged, but villous vascularity was reduced (median (interquartile range): adverse outcome 10 (10–12) vessels/mm2 vs. normal outcome 13 (12–15), p = 0.002). Adverse outcome pregnancy placental arteries were relatively insensitive to nitric oxide donated by sodium nitroprusside compared to normal outcome pregnancy placental arteries (50% Effective Concentration 30 (19–50) nM vs. 12 (6–24), p = 0.02). Adverse outcome pregnancy placental tissue contained less human chorionic gonadotrophin (20 (11–50) vs. 55 (24–102) mIU/mg, p = 0.007) and human placental lactogen (11 (6–14) vs. 27 (9–50) mg/mg, p = 0.006) and released more soluble fms-like tyrosine kinase-1 (21 (13–29) vs. 5 (2–15) ng/mg, p = 0.01) compared with normal outcome pregnancy placental tissue. Conclusion These data provide a description of the placental phenotype of adverse outcome in late pregnancy. Antenatal tests that accurately reflect elements of this phenotype may improve its prediction.
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Affiliation(s)
- Lucy E. Higgins
- Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, Manchester, M13 9WL, United Kingdom
- Maternal and Fetal Health Research Centre, St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, United Kingdom
- * E-mail:
| | - Nicolas Rey de Castro
- Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, Manchester, M13 9WL, United Kingdom
- Maternal and Fetal Health Research Centre, St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, United Kingdom
| | - Naa Addo
- Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, Manchester, M13 9WL, United Kingdom
- Maternal and Fetal Health Research Centre, St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, United Kingdom
| | - Mark Wareing
- Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, Manchester, M13 9WL, United Kingdom
- Maternal and Fetal Health Research Centre, St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, United Kingdom
| | - Susan L. Greenwood
- Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, Manchester, M13 9WL, United Kingdom
- Maternal and Fetal Health Research Centre, St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, United Kingdom
| | - Rebecca L. Jones
- Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, Manchester, M13 9WL, United Kingdom
- Maternal and Fetal Health Research Centre, St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, United Kingdom
| | - Colin P. Sibley
- Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, Manchester, M13 9WL, United Kingdom
- Maternal and Fetal Health Research Centre, St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, United Kingdom
| | - Edward D. Johnstone
- Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, Manchester, M13 9WL, United Kingdom
- Maternal and Fetal Health Research Centre, St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, United Kingdom
| | - Alexander E. P. Heazell
- Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, Manchester, M13 9WL, United Kingdom
- Maternal and Fetal Health Research Centre, St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, United Kingdom
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Evaluation of the quality of guidelines for the management of reduced fetal movements in UK maternity units. BMC Pregnancy Childbirth 2015; 15:54. [PMID: 25884544 PMCID: PMC4352260 DOI: 10.1186/s12884-015-0484-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 02/20/2015] [Indexed: 11/10/2022] Open
Abstract
Background The development of evidence-based guidelines is a key step in ensuring that maternity care is of a universally high standard. To influence patient care national and international guidelines need to be interpreted and implemented locally. In 2011, the Royal College of Obstetricians and Gynaecologists published guidelines for the management of reduced fetal movements (RFM), which can be an important symptom of fetal compromise. Following dissemination it was anticipated that this guidance would be implemented in UK maternity units. This study aimed to assess the quality of local guidelines for the management of RFM in comparison to published national standards. Methods Cross-sectional survey of maternity unit guidelines for RFM. The guidelines were assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II Tool and scored by two independent investigators. Two national guidelines were used as standards to evaluate unit guidelines. Results Responses were received from 98 units (42%); 12 units had no guideline. National guidelines scored highly using the AGREE II tool but there was wide variation in the quality of individual maternity unit guidelines, which were frequently of low quality. No guidelines incorporated all the recommendations from the national guideline. Maternity unit guidelines performed well for clarity and presentation but had low scores for stakeholder involvement, rigour of development and applicability. Conclusions In contrast to national evidence based guidance the quality of maternity unit guidelines for RFM is variable and frequently of low quality. To increase quality, guidelines need to include up to date evidence and audit standards which could be taken directly from national evidence-based guidance. Barriers to local implementation and resource implications need to be taken into consideration. Training may also improve the implementation of the guideline. Research is needed to inform strategies to realize the benefits of clinical guidance in practice.
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McArdle A, Flenady V, Toohill J, Gamble J, Creedy D. How pregnant women learn about foetal movements: sources and preferences for information. Women Birth 2014; 28:54-9. [PMID: 25457375 DOI: 10.1016/j.wombi.2014.10.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 10/03/2014] [Accepted: 10/07/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Unexplained late gestation stillbirth is a significant health issue. Antenatal information about foetal movements has been demonstrated to reduce the stillbirth rate in women with decreased foetal movements. Midwives are ideally placed to provide this information to women. AIM To investigate pregnant women's perceptions of information about foetal movements and preferences for receiving information. METHODS This prospective, descriptive study was conducted in the antenatal clinic of a large metropolitan maternity hospital. FINDINGS Pregnant women (n=526) at 34 weeks gestation or later were recruited. Only 67% of women reported receiving information about foetal movements. Women reported that midwives (80%), family (57%), friends (48%) and own mother (48%) provided this information. Midwives were the most preferred source of information. Around half (52%) of the women used the internet for information but only 11% nominated the web as their preferred information source. CONCLUSION Women prefer to be given as much information about foetal movements as possible. Women favour information from health professionals, mainly from a midwife. Midwives are well-placed to partner with pregnant women and give them unbiased and evidenced based information enabling them to make decisions and choices regarding their health and well-being. While the internet is a prevalent information source, women want to be reassured that it is trustworthy and want direction to reliable pregnancy related websites.
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Affiliation(s)
- Annie McArdle
- Griffith Health Institute, School of Nursing & Midwifery, Griffith University, University Drive, Meadowbank, Queensland 4131, Australia; Mater Research Institute, University of Queensland, Aubigny Place, Mater Health Services, Raymond Tce, South Brisbane, Queensland 4101, Australia.
| | - Vicki Flenady
- Mater Research Institute, University of Queensland, Aubigny Place, Mater Health Services, Raymond Tce, South Brisbane, Queensland 4101, Australia.
| | - Jocelyn Toohill
- Griffith Health Institute, School of Nursing & Midwifery, Griffith University, University Drive, Meadowbank, Queensland 4131, Australia.
| | - Jenny Gamble
- Griffith Health Institute, School of Nursing & Midwifery, Griffith University, University Drive, Meadowbank, Queensland 4131, Australia.
| | - Debra Creedy
- Griffith Health Institute, School of Nursing & Midwifery, Griffith University, University Drive, Meadowbank, Queensland 4131, Australia.
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Brown R, Wijekoon JHB, Fernando A, Johnstone ED, Heazell AEP. Continuous objective recording of fetal heart rate and fetal movements could reliably identify fetal compromise, which could reduce stillbirth rates by facilitating timely management. Med Hypotheses 2014; 83:410-7. [PMID: 25109874 DOI: 10.1016/j.mehy.2014.07.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 07/02/2014] [Accepted: 07/11/2014] [Indexed: 11/19/2022]
Abstract
Stillbirth currently affects approximately 1 in every 200 pregnancies in the United Kingdom. Fetuses may exhibit signs of compromise as part of a stress response before stillbirth, including reduced fetal movements (RFM) and fetal heart rate (FHR) alterations. At present, and despite widespread use, current fetal monitoring is not associated with a reduction in perinatal mortality rate (PMR) as signs of fetal compromise are not adequately detected. This may be attributed to inaccuracies resulting from manual interpretation of results or subjective assessment of fetal activity. In addition, signs of compromise often occur only hours or days before fetal death, so may be missed by current monitoring methods, which are performed intermittently. A significant consideration is that correct identification of these signs and consequent intervention can result in the delivery of a healthy baby, thus preventing stillbirth. A hypothesis is presented, proposing prompt detection of fetal compromise with the use of 24-hour continuous objective fetal monitoring. With focus placed on obtaining long-term FHR and fetal movement data, prior interest has been found in developing devices for this purpose. However, introduction into clinical practice has not been achieved. Investigation of the hypothesis will begin with the design of a device to record the mentioned parameters, followed by an appropriate validation process. Should development and testing be successful, an eventual comparison in PMR with the use of continuous fetal monitoring vs current monitoring would address the hypothesis. It is suggested that a timely yet reliable indication of fetal wellbeing obtained via long-term monitoring would allow prompt and appropriate obstetric intervention and consequently reduce PMR.
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Affiliation(s)
- Rebecca Brown
- Maternal and Fetal Health Research Centre, University of Manchester, St. Mary's Hospital, Oxford Road, Manchester M13 9WL, United Kingdom
| | - Jayawan H B Wijekoon
- School of Electrical and Electronic Engineering, University of Manchester, Sackville Street Building, Manchester M13 9PL, United Kingdom
| | - Anura Fernando
- School of Materials, University of Manchester, Oxford Road, M13 9PL, United Kingdom
| | - Edward D Johnstone
- Maternal and Fetal Health Research Centre, University of Manchester, St. Mary's Hospital, Oxford Road, Manchester M13 9WL, United Kingdom
| | - Alexander E P Heazell
- Maternal and Fetal Health Research Centre, University of Manchester, St. Mary's Hospital, Oxford Road, Manchester M13 9WL, United Kingdom.
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Maude RM, Skinner JP, Foureur MJ. Intelligent Structured Intermittent Auscultation (ISIA): evaluation of a decision-making framework for fetal heart monitoring of low-risk women. BMC Pregnancy Childbirth 2014; 14:184. [PMID: 24884597 PMCID: PMC4070350 DOI: 10.1186/1471-2393-14-184] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 05/27/2014] [Indexed: 11/17/2022] Open
Abstract
Background Research-informed fetal monitoring guidelines recommend intermittent auscultation (IA) for fetal heart monitoring for low-risk women. However, the use of cardiotocography (CTG) continues to dominate many institutional maternity settings. Methods A mixed methods intervention study with before and after measurement was undertaken in one secondary level health service to facilitate the implementation of an initiative to encourage the use of IA. The intervention initiative was a decision-making framework called Intelligent Structured Intermittent Auscultation (ISIA) introduced through an education session. Results Following the intervention, medical records review revealed an increase in the use of IA during labour represented by a relative change of 12%, with improved documentation of clinical findings from assessments, and a significant reduction in the risk of receiving an admission CTG (RR 0.75, 95% CI, 0.60 – 0.95, p = 0.016). Conclusion The ISIA informed decision-making framework transformed the practice of IA and provided a mechanism for knowledge translation that enabled midwives to implement evidence-based fetal heart monitoring for low risk women.
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Affiliation(s)
- Robyn M Maude
- Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, Newtown, PO Box 7625, Wellington, New Zealand.
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Smith V, Begley C, Devane D. Detection and management of decreased fetal movements in Ireland: A national survey of midwives' and obstetricians' practices. Midwifery 2014; 30:43-9. [DOI: 10.1016/j.midw.2013.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 02/05/2013] [Accepted: 02/16/2013] [Indexed: 10/27/2022]
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Heazell AEP, Bernatavicius G, Roberts SA, Garrod A, Whitworth MK, Johnstone ED, Gillham JC, Lavender T. A randomised controlled trial comparing standard or intensive management of reduced fetal movements after 36 weeks gestation--a feasibility study. BMC Pregnancy Childbirth 2013; 13:95. [PMID: 23590451 PMCID: PMC3640967 DOI: 10.1186/1471-2393-13-95] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 04/10/2013] [Indexed: 11/23/2022] Open
Abstract
Background Women presenting with reduced fetal movements (RFM) in the third trimester are at increased risk of stillbirth or fetal growth restriction. These outcomes after RFM are related to smaller fetal size on ultrasound scan, oligohydramnios and lower human placental lactogen (hPL) in maternal serum. We performed this study to address whether a randomised controlled trial (RCT) of the management of RFM was feasible with regard to: i) maternal recruitment and retention ii) patient acceptability, iii) adherence to protocol. Additionally, we aimed to confirm the prevalence of poor perinatal outcomes defined as: stillbirth, birthweight <10th centile, umbilical arterial pH <7.1 or unexpected admission to the neonatal intensive care unit. Methods Women with RFM ≥36 weeks gestation were invited to participate in a RCT comparing standard management (ultrasound scan if indicated, induction of labour (IOL) based on consultant decision) with intensive management (ultrasound scan, maternal serum hPL, IOL if either result was abnormal). Anxiety was assessed by state-trait anxiety index (STAI) before and after investigations for RFM. Rates of protocol compliance and IOL for RFM were calculated. Participant views were assessed by questionnaires. Results 137 women were approached, 120 (88%) participated, 60 in each group, 2 women in the standard group did not complete the study. 20% of participants had a poor perinatal outcome. All women in the intensive group had ultrasound assessment of fetal size and liquor volume vs. 97% in the standard group. 50% of the intensive group had IOL for abnormal scan or low hPL after RFM vs. 26% of controls (p < 0.01). STAI reduced for all women after investigations, but this reduction was greater in the standard group (p = 0.02). Participants had positive views about their involvement in the study. Conclusion An RCT of management of RFM is feasible with a low rate of attrition. Investigations decrease maternal anxiety. Participants in the intensive group were more likely to have IOL for RFM. Further work is required to determine the likely level of intervention in the standard care arm in multiple centres, to develop additional placental biomarkers and to confirm that the composite outcome is valid. Trial registration ISRCTN07944306
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Affiliation(s)
- Alexander E P Heazell
- Maternal and Fetal Health Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
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Dutton PJ, Warrander LK, Roberts SA, Bernatavicius G, Byrd LM, Gaze D, Kroll J, Jones RL, Sibley CP, Frøen JF, Heazell AEP. Predictors of poor perinatal outcome following maternal perception of reduced fetal movements--a prospective cohort study. PLoS One 2012; 7:e39784. [PMID: 22808059 PMCID: PMC3394759 DOI: 10.1371/journal.pone.0039784] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 05/30/2012] [Indexed: 11/24/2022] Open
Abstract
Background Maternal perception of reduced fetal movement (RFM) is associated with increased risk of stillbirth and fetal growth restriction (FGR). RFM is thought to represent fetal compensation to conserve energy due to insufficient oxygen and nutrient transfer resulting from placental insufficiency. Objective To identify predictors of poor perinatal outcome after maternal perception of reduced fetal movements (RFM). Design Prospective cohort study. Methods 305 women presenting with RFM after 28 weeks of gestation were recruited. Demographic factors and clinical history were recorded and ultrasound performed to assess fetal biometry, liquor volume and umbilical artery Doppler. A maternal serum sample was obtained for measurement of placentally-derived or modified proteins including: alpha fetoprotein (AFP), human chorionic gonadotrophin (hCG), human placental lactogen (hPL), ischaemia-modified albumin (IMA), pregnancy associated plasma protein A (PAPP-A) and progesterone. Factors related to poor perinatal outcome were determined by logistic regression. Results 22.1% of pregnancies ended in a poor perinatal outcome after RFM. The most common complication was small-for-gestational age infants. Pregnancy outcome after maternal perception of RFM was related to amount of fetal activity while being monitored, abnormal fetal heart rate trace, diastolic blood pressure, estimated fetal weight, liquor volume, serum hCG and hPL. Following multiple logistic regression abnormal fetal heart rate trace (Odds ratio 7.08, 95% Confidence Interval 1.31–38.18), (OR) diastolic blood pressure (OR 1.04 (95% CI 1.01–1.09), estimated fetal weight centile (OR 0.95, 95% CI 0.94–0.97) and log maternal serum hPL (OR 0.13, 95% CI 0.02–0.99) were independently related to pregnancy outcome. hPL was related to placental mass. Conclusion Poor perinatal outcome after maternal perception of RFM is closely related to factors which are connected to placental dysfunction. Novel tests of placental function and associated fetal response may provide improved means to detect fetuses at greatest risk of poor perinatal outcome after RFM.
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Affiliation(s)
- Philip J. Dutton
- Maternal and Fetal Health Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Lynne K. Warrander
- Maternal and Fetal Health Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Stephen A. Roberts
- Health Sciences – Methodology, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Giovanna Bernatavicius
- Department of Obstetrics, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Louise M. Byrd
- Department of Obstetrics, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - David Gaze
- Department of Chemical Pathology, St George's Hospital Medical School, London, United Kingdom
| | - Josh Kroll
- Maternal and Fetal Health Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Rebecca L. Jones
- Maternal and Fetal Health Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Colin P. Sibley
- Maternal and Fetal Health Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - J. Frederik Frøen
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Alexander E. P. Heazell
- Maternal and Fetal Health Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- Department of Obstetrics, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
- * E-mail:
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Peat AM, Stacey T, Cronin R, McCowan LME. Maternal knowledge of fetal movements in late pregnancy. Aust N Z J Obstet Gynaecol 2012; 52:445-9. [DOI: 10.1111/j.1479-828x.2012.01462.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 05/15/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Andrea M. Peat
- Department of Obstetrics and Gynaecology; University of Auckland; Auckland; New Zealand
| | - Tomasina Stacey
- Department of Obstetrics and Gynaecology; University of Auckland; Auckland; New Zealand
| | - Robin Cronin
- Department of Obstetrics and Gynaecology; University of Auckland; Auckland; New Zealand
| | - Lesley M. E. McCowan
- Department of Obstetrics and Gynaecology; University of Auckland; Auckland; New Zealand
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Abstract
BACKGROUND Clinical observations indicate that mothers commonly perceive a reduction in, or absence of, the baby's movements for some days preceding a baby's death. For this reason, fetal movement monitoring is advised by caregivers and used spontaneously by mothers to assess the baby's well-being. However, it is possible that the harmful effects of interventions may outweigh the benefits of such testing. Evidence of effectiveness of fetal movement screening to improve outcomes is limited, though indirect evidence suggests a potential benefit. A secondary question is whether any specific management response to perceived decreased fetal movements (DFM) improves clinical outcome. OBJECTIVES To determine, from the best available evidence, the effectiveness of various management strategies for DFM. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (28 February 2012) and bibliographies of included studies. SELECTION CRITERIA Randomised clinical trials comparing various management strategies for DFM, including delivery, expectant management, cardiotocography (visual and computerised), ultrasound examination including Doppler ultrasound, and fetal arousal tests (cardiotocographic or clinical). DATA COLLECTION AND ANALYSIS Two assessors evaluated potentially eligible trials for inclusion, and extracted data onto a purpose-designed form. Where DFM was one among a number of inclusion criteria for the trial, we contacted trial authors for information on outcomes specific to the DFM subgroups. MAIN RESULTS No randomised trials of management of DFM were found. Of 13 randomised trials of management strategies for pregnancies with risk factors for fetal compromise including DFM, data on the DFM subgroups could only be provided by the authors of one trial. The numbers were too small for meaningful analysis (there were 28 cases of DFM). AUTHORS' CONCLUSIONS There are insufficient data from randomised trials to guide practice regarding the management of DFM. Based on the results of other systematic reviews of management strategies for women whose babies are thought to be at risk of compromise for various reasons, the following strategies show promise and may be prioritised for further research: Doppler ultrasound studies, computerised cardiotocography, and fetal arousal to facilitate cardiotocography.For settings where electronic fetal assessment methods are not available, clinical fetal arousal tests should be investigated.
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Affiliation(s)
- G Justus Hofmeyr
- Department of Obstetrics and Gynaecology, East London Hospital Complex, University of the Witwatersrand, University of FortHare, Eastern Cape Department of Health, East London, South Afric.
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Maternal perception of reduced fetal movements is associated with altered placental structure and function. PLoS One 2012; 7:e34851. [PMID: 22523561 PMCID: PMC3327709 DOI: 10.1371/journal.pone.0034851] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 03/09/2012] [Indexed: 11/20/2022] Open
Abstract
Background Maternal perception of reduced fetal movement (RFM) is associated with increased risk of stillbirth and fetal growth restriction (FGR). DFM is thought to represent fetal compensation to conserve energy due to insufficient oxygen and nutrient transfer resulting from placental insufficiency. To date there have been no studies of placental structure in cases of DFM. Objective To determine whether maternal perception of reduced fetal movements (RFM) is associated with abnormalities in placental structure and function. Design Placentas were collected from women with RFM after 28 weeks gestation if delivery occurred within 1 week. Women with normal movements served as a control group. Placentas were weighed and photographs taken. Microscopic structure was evaluated by immunohistochemical staining and image analysis. System A amino acid transporter activity was measured as a marker of placental function. Placentas from all pregnancies with RFM (irrespective of outcome) had greater area with signs of infarction (3.5% vs. 0.6%; p<0.01), a higher density of syncytial knots (p<0.001) and greater proliferation index (p<0.01). Villous vascularity (p<0.001), trophoblast area (p<0.01) and system A activity (p<0.01) were decreased in placentas from RFM compared to controls irrespective of outcome of pregnancy. Conclusions This study provides evidence of abnormal placental morphology and function in women with RFM and supports the proposition of a causal association between placental insufficiency and RFM. This suggests that women presenting with RFM require further investigation to identify those with placental insufficiency.
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Saastad E, Winje BA, Israel P, Frøen JF. Fetal movement counting--maternal concern and experiences: a multicenter, randomized, controlled trial. Birth 2012; 39:10-20. [PMID: 22369601 DOI: 10.1111/j.1523-536x.2011.00508.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fetal movement counting may improve timely identification of decreased fetal activity and thereby contribute to prevent adverse pregnancy outcomes, but it may also contribute to maternal concern. This study aimed to test whether fetal movement counting increased maternal concern. METHODS In a multicenter, controlled trial 1,013 women with a singleton pregnancy were randomly assigned either to perform daily fetal movement counting from pregnancy week 28 or to follow standard Norwegian antenatal care where fetal movement counting is not encouraged. The primary outcome was maternal concern, measured by the Cambridge Worry Scale. Analysis was by intention-to-treat. RESULTS The means and SDs on Cambridge Worry Scale scores were 0.77 (0.55) and 0.90 (0.62) for the intervention and the control groups, respectively, a mean difference between the groups of 0.14 (95% CI: 0.06-0.21, p<0.001). Decreased fetal activity was of concern to 433 women once or more during pregnancy, 45 and 42 percent in the intervention and control groups, respectively (relative risk=1.1, 95% CI: 0.9-1.2). Seventy-nine percent of the women responded favorably to the use of counting charts. CONCLUSIONS Women who performed fetal movement counting in the third trimester reported less concern than those in the control group. The frequency of maternal report of concern about decreased fetal activity was similar between the groups. Most women considered the use of a counting chart to be positive.
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Affiliation(s)
- Eli Saastad
- AkershusUniversity College, PB 423, N-2001 Lillestrøm, Norway
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Saastad E, Winje BA, Stray Pedersen B, Frøen JF. Fetal movement counting improved identification of fetal growth restriction and perinatal outcomes--a multi-centre, randomized, controlled trial. PLoS One 2011; 6:e28482. [PMID: 22205952 PMCID: PMC3244397 DOI: 10.1371/journal.pone.0028482] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 11/09/2011] [Indexed: 12/02/2022] Open
Abstract
Background Fetal movement counting is a method used by the mother to quantify her baby's movements, and may prevent adverse pregnancy outcome by a timely evaluation of fetal health when the woman reports decreased fetal movements. We aimed to assess effects of fetal movement counting on identification of fetal pathology and pregnancy outcome. Methodology In a multicentre, randomized, controlled trial, 1076 pregnant women with singleton pregnancies from an unselected population were assigned to either perform fetal movement counting from gestational week 28, or to receive standard antenatal care not including fetal movement counting (controls). Women were recruited from nine Norwegian hospitals during September 2007 through November 2009. Main outcome was a compound measure of fetal pathology and adverse pregnancy outcomes. Analysis was performed by intention-to-treat. Principal Findings The frequency of the main outcome was equal in the groups; 63 of 433 (11.6%) in the intervention group, versus 53 of 532 (10.7%) in the control group [RR: 1.1 95% CI 0.7–1.5)]. The growth-restricted fetuses were more often identified prior to birth in the intervention group than in the control group; 20 of 23 fetuses (87.0%) versus 12 of 20 fetuses (60.0%), respectively, [RR: 1.5 (95% CI 1.0–2.1)]. In the intervention group two babies (0.4%) had Apgar scores <4 at 1 minute, versus 12 (2.3%) in the control group [RR: 0.2 (95% CI 0.04–0.7)]. The frequency of consultations for decreased fetal movement was 71 (13.1%) and 57 (10.7%) in the intervention and control groups, respectively [RR: 1.2 (95% CI 0.9–1.7)]. The frequency of interventions was similar in the groups. Conclusions Maternal ability to detect clinically important changes in fetal activity seemed to be improved by fetal movement counting; there was an increased identification of fetal growth restriction and improved perinatal outcome, without inducing more consultations or obstetric interventions. Trial Registration ClinicalTrials.govNCT00513942
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Affiliation(s)
- Eli Saastad
- Faculty of Health, Nutrition and Management, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
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Debord MP. Place du compte des mouvements actifs fœtaux et de l’amnioscopie dans la surveillance des grossesses prolongées. ACTA ACUST UNITED AC 2011; 40:767-73. [DOI: 10.1016/j.jgyn.2011.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Saastad E, Israel P, Ahlborg T, Gunnes N, Frøen JF. Fetal movement counting--effects on maternal-fetal attachment: a multicenter randomized controlled trial. Birth 2011; 38:282-93. [PMID: 22112328 DOI: 10.1111/j.1523-536x.2011.00489.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Women presenting with decreased fetal movement have an increased risk of adverse pregnancy outcomes. Fetal movement counting may be associated with improvement in maternal-fetal attachment, which in turn, improves pregnancy outcome and postnatal mother-infant attachment. The study aim was to test whether maternal-fetal attachment differed between groups of mothers who systematically performed fetal movement counting and mothers who followed standard antenatal care where routine fetal movement counting was discouraged. METHODS In a multicenter, randomized trial, 1,123 women were assigned to either systematic fetal movement counting from pregnancy week 28 or to standard antenatal care. This study sample included primarily white, cohabiting, nonsmoking, and relatively well-educated women. The outcome measure was maternal-fetal attachment, measured by using the Prenatal Attachment Inventory. Analysis was by intention-to-treat. RESULTS No difference was found between the groups in the scores on prenatal attachment; the means and standard deviations were 59.54 (9.39) and 59.34 (9.75) [corrected] for the intervention and the control groups, respectively (p = 0.747). The mean difference between the groups was 0.20 (95% CI: -1.02-1.42) [corrected]. CONCLUSIONS Fetal movement counting in the third trimester does not stimulate antenatal maternal-fetal attachment. This result differs from a previous study where fetal movement counting improved maternal-fetal attachment. Further research with a focus on possible mediating factors such as levels of stress, concern, and other psychological factors is required.
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Affiliation(s)
- Eli Saastad
- Akershus University College, Lillestrøm, Norway
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Daly N, Brennan D, Foley M, O’Herlihy C. Cardiotocography as a predictor of fetal outcome in women presenting with reduced fetal movement. Eur J Obstet Gynecol Reprod Biol 2011; 159:57-61. [DOI: 10.1016/j.ejogrb.2011.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 05/19/2011] [Accepted: 07/11/2011] [Indexed: 10/17/2022]
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ERLANDSSON KERSTIN, LINDGREN HELENA, DAVIDSSON-BREMBORG ANNA, RÅDESTAD INGELA. Women's premonitions prior to the death of their baby in utero and how they deal with the feeling that their baby may be unwell. Acta Obstet Gynecol Scand 2011; 91:28-33. [DOI: 10.1111/j.1600-0412.2011.01209.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Winje BA, Saastad E, Gunnes N, Tveit JVH, Stray-Pedersen B, Flenady V, Frøen JF. Analysis of ‘count-to-ten’ fetal movement charts: a prospective cohort study. BJOG 2011; 118:1229-38. [DOI: 10.1111/j.1471-0528.2011.02993.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hofmeyr GJ, Novikova N. Management of reported decreased fetal movements for improving pregnancy outcomes. Cochrane Database Syst Rev 2011. [DOI: 10.1002/14651858.cd009148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Olagbuji BN, Ezeanochie MC, Kubeyinje W, Dunsin T, Ande AB. Pregnancy outcome following induction of labor with intravaginal misoprostol for decreased fetal movements at term. J Matern Fetal Neonatal Med 2011; 24:1225-7. [DOI: 10.3109/14767058.2011.572309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Gestational diabetes mellitus (GDM) is commonly defined as glucose intolerance first recognized during pregnancy. Diagnostic criteria for GDM have changed over the decades, and several definitions are currently used; recent recommendations may increase the prevalence of GDM to as high as one of five pregnancies. Perinatal complications associated with GDM include hypertensive disorders, preterm delivery, shoulder dystocia, stillbirths, clinical neonatal hypoglycemia, hyperbilirubinemia, and cesarean deliveries. Postpartum complications include obesity and impaired glucose tolerance in the offspring and diabetes and cardiovascular disease in the mothers. Management strategies increasingly emphasize optimal management of fetal growth and weight. Monitoring of glucose, fetal stress, and fetal weight through ultrasound combined with maternal weight management, medical nutritional therapy, physical activity, and pharmacotherapy can decrease comorbidities associated with GDM. Consensus is lacking on ideal glucose targets, degree of caloric restriction and content, algorithms for pharmacotherapy, and in particular, the use of oral medications and insulin analogs in lieu of human insulin. Postpartum glucose screening and initiation of healthy lifestyle behaviors, including exercise, adequate fruit and vegetable intake, breastfeeding, and contraception, are encouraged to decrease rates of future glucose intolerance in mothers and offspring.
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Affiliation(s)
- Catherine Kim
- Departments of Medicine and Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.
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Hijazi ZR, Callan SE, East CE. Maternal perception of foetal movement compared with movement detected by real-time ultrasound: an exploratory study. Aust N Z J Obstet Gynaecol 2010; 50:144-7. [PMID: 20522070 DOI: 10.1111/j.1479-828x.2009.01122.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In this exploratory study, women perceived 35.8% of 763 foetal movements seen on 14 ultrasound scans, with increased sensitivity when movements involved more than one foetal body part (adjusted odds ratio (OR) 1.92, 95% confidence interval (CI) 1.232-2.999), contacted the uterus (adjusted OR: 2.57, 95% CI: 1.653-3.995) and were of increasing duration (adjusted OR: 9.33, 95% CI: 5.616-15.513). These findings may inform future studies of the importance of and ability to improve women's perception of foetal movements.
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Affiliation(s)
- Zina R Hijazi
- Department of Obstetrics & Gynaecology, University of Melbourne, Melbourne, Victoria
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