Abstract
(Abstracted from Lancet 2018;392:1629–1638) Two to 6 million pregnancies were estimated to have ended in stillbirth in 2015. The aim of the AFFIRM study was to test the hypothesis that introduction of a reduced fetal movement care package for pregnant women and clinicians that increased women's awareness of the need for prompt reporting of RFM and that standardized management, including timely delivery, would alter the incidence of stillbirth.
Highlights
Stillbirth is a pervasive problem worldwide. 2·6 million babies were estimated to have died in utero in 2015.1 In high-income countries (HICs), one in 113–769 preg nancies end in stillbirth after 28 weeks.[2]
reduced fetal movement (RFM) is associated with fetal growth restriction[5] and placental abnormalities in pregnancies that do not end in stillbirth.[6,7]
RFM is only modestly associated with increased risk of stillbirth,[8,9] and whether RFM is a symptom of inevitable fetal death or whether it can be used as an alert to prompt action and improve outcome is unclear
Summary
Stillbirth is a pervasive problem worldwide. 2·6 million babies were estimated to have died in utero in 2015.1 In high-income countries (HICs), one in 113–769 preg nancies end in stillbirth after 28 weeks.[2]. 2·6 million babies were estimated to have died in utero in 2015.1 In high-income countries (HICs), one in 113–769 preg nancies end in stillbirth after 28 weeks.[2] Most stillbirths happen without fetal abnormality or pre-existing risk factors for stillbirth. Maternal perception of reduced fetal movement (RFM) has been identified as a potential strategy for stillbirth prevention. 30–55% of women whose pregnancies end in stillbirth experience RFM in the preceding week.[3,4] RFM is associated with fetal growth restriction[5] and placental abnormalities in pregnancies that do not end in stillbirth.[6,7] RFM is only modestly associated with increased risk of stillbirth (odds ratios [OR] 2·37–14·1),[8,9] and whether RFM is a symptom of inevitable fetal death or whether it can be used as an alert to prompt action and improve outcome is unclear. In a Cochrane review (dominated by one cluster-randomised trial of 68 000 women allocated to formal kick counting or usual treatment10), formal fetal movement counting was concluded to be of uncertain benefit as a test of fetal wellbeing.[11]
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