Stillbirths preceded by reduced fetal movements are more frequently associated with placental insufficiency: a retrospective cohort study.

Madeleine ter Kuile,Jan Jaap H.M. Erwich,Alexander E.P. Heazell

doi:10.1515/jpm-2021-0103

Abstract

Maternal report of reduced fetal movements (RFM) is a means of identifying fetal compromise in pregnancy. In live births RFM is associated with altered placental structure and function. Here, we explored associations between RFM, pregnancy characteristics, and the presence of placental abnormalities and fetal growth restriction (FGR) in cases of stillbirth. A retrospective cohort study was carried out in a single UK tertiary maternity unit. Cases were divided into three groups: 109 women reporting RFM, 33 women with absent fetal movements (AFM) and 159 who did not report RFM before the diagnosis of stillbirth. Univariate and multivariate logistic regression was used to determine associations between RFM/AFM, pregnancy characteristics, placental insufficiency and the classification of the stillbirth. AFM or RFM were reported prior to diagnosis of stillbirth in 142 (47.2%) of cases. Pregnancies with RFM prior to diagnosis of stillbirth were independently associated with placental insufficiency (Odds Ratio (OR) 2.79, 95% Confidence Interval (CI) 1.84, 5.04) and were less frequently associated with maternal proteinuria (OR 0.16, 95% CI 0.07, 0.62) and previous pregnancy loss <24weeks (OR 0.20, 95% CI 0.07, 0.70). When combined, AFM and RFM were less frequently reported in twin pregnancies ending in stillbirth and in intrapartum stillbirths. The association between RFM and placental insufficiency was confirmed in cases of stillbirth. This provides further evidence that RFM is a symptom of placental insufficiency. Therefore, investigation after RFM should aim to identify placental dysfunction.

Highlights

Stillbirth is an extensive problem that receives little attention from worldwide initiatives [1]
Pregnancies with reduced fetal movements (RFM) prior to diagnosis of stillbirth were independently associated with placental insufficiency (Odds Ratio (OR) 2.79, 95% Confidence Interval (CI) 1.84, 5.04) and were less frequently associated with maternal proteinuria and previous pregnancy loss
The cohort of 301 cases of stillbirth included 142 women (47.2%, 95% confidence interval 46.1–52.8%) which presented with absent fetal movements (AFM) or RFM and 159 (52.8%) who had no evidence of abnormal fetal activity; 109 women had RFM and 33 reported AFM

Summary

Introduction

Stillbirth is an extensive problem that receives little attention from worldwide initiatives [1]. Only 2% of the 2.8 million stillbirths each year occur in high-income countries (HICs), this still accounts for significant number of deaths [2]. Stillbirth prevention is a major challenge; despite efforts to reduce it, the stillbirth rate has only decreased at 1.4% per year in the UK since 2000 [3]. In 2015, the UK stillbirth rate (3.9 per 1,000 live births after 28 weeks’ gestation) was still in excess of the European average [3]. If all HICs achieved a stillbirth rate comparable to the six best performing countries it is estimated that over 20,000 stillbirths could be prevented [3].

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