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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.

Objective To pilot a clinical information service for general practitioners. Methods A representative sample of 31 GPs was invited to submit clinical questions to a local academic department of general practice. Their views on the service and the usefulness of the information were obtained by telephone interview. Results Over one month, nine GPs (29% of the sample, 45% of those stating an interest), submitted 20 enquiries comprising 45 discrete clinical questions. The median time to search for evidence, appraise it and write answers to each enquiry was 2.5 hours (range, 1.0–7.4 hours). The median interval between receipt of questions and dispatch of answers was 3 days (range, 1–12 days). Conclusions The GPs found the answers useful in clinical decision making; in four out of 20 cases patient management was altered.

Background In 2015, the stillbirth rate after 28 weeks (late gestation) in Australia was 35% higher than countries with the lowest rates globally. Reductions in late gestation stillbirth rates have steadily improved in Australia. However, to amplify and sustain reductions, more needs to be done to reduce practice variation and address sub-optimal care. Implementing bundles for maternity care improvement in the UK have been associated with a 20% reduction in stillbirth rates. A similar approach is underway in Australia; the Safer Baby Bundle (SBB) with five elements: 1) supporting women to stop smoking in pregnancy, 2) improving detection and management of fetal growth restriction, 3) raising awareness and improving care for women with decreased fetal movements, 4) improving awareness of maternal safe going-to-sleep position in late pregnancy, 5) improving decision making about the timing of birth for women with risk factors for stillbirth. Methods This is a mixed-methods study of maternity services across three Australian states; Queensland, Victoria and New South Wales. The study includes evaluation of ‘targeted’ implementer sites (combined total approximately 113,000 births annually, 50% of births in these states) and monitoring of key outcomes state-wide across all maternity services. Progressive implementation over 2.5 years, managed by state Departments of Health, commenced from mid-2019. This study will determine the impact of implementing the SBB on maternity services and perinatal outcomes, specifically for reducing late gestation stillbirth. Comprehensive process, impact, and outcome evaluations will be conducted using routinely collected perinatal data, pre- and post- implementation surveys, clinical audits, focus group discussions and interviews. Evaluations explore the views and experiences of clinicians embedding the SBB into routine practice as well as women’s experience with care and the acceptability of the initiative. Discussion This protocol describes the evaluation of the SBB initiative and will provide evidence for the value of a systematic, but pragmatic, approach to strategies to reduce the evidence-practice gaps across maternity services. We hypothesise successful implementation and uptake across three Australian states (amplified nationally) will be effective in reducing late gestation stillbirths to that of the best performing countries globally, equating to at least 150 lives saved annually. Trial registration The Safer Baby Bundle Study was retrospectively registered on the ACTRN12619001777189 database, date assigned 16/12/2019

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Phase II included another 6-month period of data collection on cesarean births with emphasis on improving dialog between nurses and physicians. Each case was accompanied by a worksheet completed and signed by both the physicians and nurses. A second operating room (OR) was made available for emergency cases. Ongoing education regarding the 30-minute standard was available during this phase. The standard was met in 45% of the cases and the average time for DI dropped to 37 minutes.Phase III saw the implementation of a new work flow which simplified communication and emphasized teamwork. Two OR's and 2 anesthesiologists were made available specifically for cesarean deliveries. It was decided that all patients would be moved to the OR in 5-10 minutes without delaying for patient consent and that IV's, Foley's, and compression devices would be accomplished in the OR rather than in the labor area. This has proved to be a critical factor in obtaining the goals of the standard. The standard was met in 56% of cases and the length of time for DI decreased to 33 minutes.During phase IV, data collection and reporting were made more visible and times from decision to transport and DI were tracked. Monthly results were posted in the physicians' and nurses' lounges and graphic images displayed progress. Those cases which were >30 minutes were displayed with reasons for the delay. Medical personnel were not identified but the caregivers were contacted individually. The DI time decreased to 27 minutes and the standard was met in 65% of cases.The final phase began the initiation of "Code Green," which announced to all labor and delivery personnel the need for cesarean section for fetal intolerance to labor. Code Green announcement allowed for immediate attention and prioritization to emergency cases. With the initiation of Code Green, over 90% of the cases met the standard, the mean DI time dropped to <25 minutes, and 100% of the cases began within 40 minutes.This study shows that the implementation and achievement of the 30-minute standard is difficult. Efforts to improve timely delivery require continuous communication, data collection, analysis and discussion, and the willingness to change.Topics: Pharmacology, Neonatal Morbidity and Mortality, Maternal Morbidity and Mortality W omen with threatened or planned preterm birth (< 35-wk gestation) should be given a single course of antenatal glucocorticoids. This treatment has been shown to increase the effectiveness of postnatal surfactant therapy in the neonate, to reduce health care costs, and likely reduces the rate of child disability. Despite numerous studies showing their effectiveness, repeated antenatal glucocorticoid therapy remains controversial as there are concerns about the long-term effects of these treatments. The purpose of this study was to determine the safety and

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