Implementation of uniform information on fetal movement in a Norwegian population reduced delayed reporting of decreased fetal movement and stillbirths in primiparous women - a clinical quality improvement.

Eli Saastad,Julie Tveit,Vicki Flenady,Babill Stray-Pedersen,J Frederik Frøen,Per E Børdahl,Ruth C Fretts

doi:10.1186/1756-0500-3-2

Abstract

BackgroundDelayed maternal reporting of decreased fetal movement (DFM) is associated with adverse pregnancy outcomes. Inconsistent information on fetal activity to women during the antenatal period may result in delayed reporting of DFM. We aimed to evaluate an intervention of implementation of uniform information on fetal activity to women during the antenatal period.MethodsIn a prospective before-and-after study, singleton women presenting DFM in the third trimester across 14 hospitals in Norway were registered. Outcome measures were maternal behavior regarding reporting of DFM, concerns and stillbirth. In addition, cross-sectional studies of all women giving birth were undertaken to assess maternal concerns about fetal activity, and population-based data were obtained from the Medical Birth Registry Norway.ResultsPre- and post-intervention cohorts included 19 407 and 46 143 births with 1 215 and 3 038 women with DFM respectively. Among primiparous women with DFM, a reduction in delayed reporting of DFM (≥48 hrs) OR 0.61 (95% CI 0.47-0.81) and stillbirths OR 0.36 (95% CI 0.19-0.69) was shown in the post-intervention period. No difference was shown in rates of consultations for DFM or maternal concerns. Stillbirth rates and maternal behavior among women who were of non-Western origin, smokers, overweight or >34 years old were unchanged.ConclusionsUniform information on fetal activity provided to pregnant women was associated with a reduction in the number of primiparous women who delayed reporting of DFM and a reduction of the stillbirth rates for primiparous women reporting DFM. The information did not appear to increase maternal concerns or rate of consultation. Due to different imperfections in different clinical settings, further studies in other populations replicating these findings are required.

Highlights

Delayed maternal reporting of decreased fetal movement (DFM) is associated with adverse pregnancy outcomes
This paper reports the effects of providing uniform information about fetal activity on maternal awareness, behavior, concerns and pregnancy outcomes when DFM was perceived by the mothers
Potential recall bias and the validity of the cross-sectional questionnaire have been discussed elsewhere [10]. While these findings are encouraging, caution in its interpretation is warranted due to limitations of the design employed in this quality improvement project; the implemented solutions were based on the local existing imperfections found by prior data collections of quality indicators

Summary

Introduction

Delayed maternal reporting of decreased fetal movement (DFM) is associated with adverse pregnancy outcomes. Inconsistent information on fetal activity to women during the antenatal period may result in delayed reporting of DFM. FMC is not promoted as a universal screening tool for fetal wellbeing [4], but has been recommended in high-risk pregnancies [12,13]. The most important clinical screening tool for DFM for identifying high-risk pregnancies is the women’s own perception of a decrease [8,14,15,16]; i.e. her perception of a change, not the crossing of a given limit. Existing guidelines for antenatal care in the United Kingdom, the US and Norway recommend that a distinct reduction of fetal movement should be reported and lead to further investigation [17,18,19,20]. Four to fifteen percent of women present to the hospital in late pregnancy with the primary complaint of reduced or absent fetal movements [8,21,22]

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