Abstract
BackgroundWomen experiencing decreased fetal movements (DFM) are at increased risk of adverse outcomes, including stillbirth. Fourteen delivery units in Norway registered all cases of DFM in a population-based quality assessment. We found that information to women and management of DFM varied significantly between hospitals. We intended to examine two cohorts of women with DFM before and during two consensus-based interventions aiming to improve care through: 1) written information to women about fetal activity and DFM, including an invitation to monitor fetal movements, 2) guidelines for management of DFM for health-care professionals.MethodsAll singleton third trimester pregnancies presenting with a perception of DFM were registered, and outcomes collected independently at all 14 hospitals. The quality assessment period included April 2005 through October 2005, and the two interventions were implemented from November 2005 through March 2007. The baseline versus intervention cohorts included: 19,407 versus 46,143 births and 1215 versus 3038 women with DFM, respectively.ResultsReports of DFM did not increase during the intervention. The stillbirth rate among women with DFM fell during the intervention: 4.2% vs. 2.4%, (OR 0.51 95% CI 0.32–0.81), and 3.0/1000 versus 2.0/1000 in the overall study population (OR 0.67 95% CI 0.48–0.93). There was no increase in the rates of preterm births, fetal growth restriction, transfers to neonatal care or severe neonatal depression among women with DFM during the intervention. The use of ultrasound in management increased, while additional follow up visits and admissions for induction were reduced.ConclusionImproved management of DFM and uniform information to women is associated with fewer stillbirths.
Highlights
Women experiencing decreased fetal movements (DFM) are at increased risk of adverse outcomes, including stillbirth
The number of women presenting with DFM remained unchanged during intervention at 6.3% versus 6.6%, respectively
The stillbirth rates among women with DFM were reduced by almost 50%) from 4.2% (n = 50) to 2.4% (n = 73) during the intervention
Summary
Women experiencing decreased fetal movements (DFM) are at increased risk of adverse outcomes, including stillbirth. A common factor in these studies is that the mother is lying down and focusing on fetal activity This is the only situation in which we know that maternal perception and objective measures of FM are strongly correlated with objective measures of fetal activity. Outside such a setting, both the actual frequency of movements as well as the mother's ability to perceive them are influenced by factors such as maternal position [13], activity and exercise [14], anxiety [15], stress [16], blood sugar [17], smoking [18], placenta localization [10], and obesity [19]. There are significant diurnal variations in normal fetal activity, which changes gradually with gestation [10,20]
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