Alterations in maternally perceived fetal movement and their association with late stillbirth: findings from the Midland and North of England stillbirth case–control study

Abstract

ObjectiveTo report perception of fetal movements in women who experienced a stillbirth compared with controls at a similar gestation with a live birth.DesignCase–control study.Setting41 maternity units in the UK.ParticipantsCases were women who had a late stillbirth ≥28 weeks gestation (n=291) and controls were women with an ongoing pregnancy at the time of the interview (n=733). Controls were frequency matched to cases by obstetric unit and gestational age.MethodsData were collected using an interviewer-administered questionnaire which included questions on maternal perception of fetal movement (frequency, strength, increased and decreased movements and hiccups) in the 2 weeks before the interview/stillbirth. Five fetal movement patterns were identified incorporating the changes in strength and frequency in the last 2 weeks by combining groups of similar pattern and risk. Multivariable analysis adjusted for known confounders.Primary outcome measureAssociation of maternally perceived fetal movements in relation to late stillbirth.ResultsIn multivariable analyses, women who reported increased strength of movements in the last 2 weeks had decreased risk of late stillbirth compared with those whose movements were unchanged (adjusted OR (aOR) 0.18, 95% CI 0.13 to 0.26). Women with decreased frequency (without increase in strength) of fetal movements were at increased risk (aOR 4.51, 95% CI 2.38 to 8.55). Daily perception of fetal hiccups was protective (aOR 0.31, 95% CI 0.17 to 0.56).ConclusionsIncreased strength of fetal movements and fetal hiccups is associated with decreased risk of stillbirth. Alterations in frequency of fetal movements are important in identifying pregnancies at increased risk of stillbirth, with the greatest risk in women noting a reduction in fetal activity. Clinical guidance should be updated to reflect that increase in strength and frequency of fetal movements is associated with the lowest risk of stillbirth, and that decreased fetal movements are associated with stillbirth.Trial registration numberNCT02025530.

Investigation of the outcome of pregnancies complicated by increased fetal movements and their relation to underlying causes – A prospective cohort study

“…The participating maternity units serve an ethnically and socially diverse population, suggesting these findings may be generalizable. However, the study recruited fewer women than anticipated, the incidence of 0.45% of women being much lower than 9.6% reported in a prospective study from China 13 and 6.9% of controls in MiNESS 4 . As women perceiving IFM are not routinely asked to contact maternity services in the UK, women perceiving this symptom may not have been recruited.…”

“…In recent years, evidence has emerged to suggest that maternal perception of a single episode of abnormally increased fetal movements (IFM) may be associated with stillbirth, 4‐8 with a twofold, 4 fourfold 5 and sevenfold 6 risk of stillbirth, respectively. Importantly, only a single episode of IFM is associated with an increased risk of stillbirth, with multiple episodes of IFM being protective 4‐6 . This has led to the suggestion that a single episode of IFM could represent an acute in utero event 9 …”

“…All studies reporting an increased stillbirth risk associated with an episode of IFM are retrospective cohort or case‐control studies and are subject to a risk of recall and negativity bias 4‐6 and in some instances selection bias 7,8 . Thus, to evaluate further the association between IFMs and adverse pregnancy outcomes, and to characterize any underlying potential pathologies, prospective studies are needed.…”

Standard care informed by the result of a placental growth factor blood test versus standard care alone in women with reduced fetal movement at or after 36+0 weeks’ gestation: a pilot randomised controlled trial

“…In 2015, the stillbirth rate in the UK ranked 24th out of 49 high-income countries [1] and while the rate has declined over recent years [2], further reduction is a national priority [3]. Maternal perception of reduced fetal movements (RFM) is associated with stillbirth [3][4][5][6][7] and is thought to be a symptom of placental dysfunction restricting the supply of nutrients or oxygen to the fetus [8,9]. A systematic review of management for RFM concluded that there was insufficient evidence to guide practice and that highquality trials were required [10].…”

Decreased fetal movement and mobile application interventions during pregnancy

“…A similar case-control study in the U.K. found that women who reported decreased frequency of fetal movements (without increase of strength) in the last 2 weeks were at increased risk of stillbirth (aOR 4.51, 95% CI: 2.38-8.55) 39 . A further study by O'Sullivan et al described a 2to 3-fold increased risk of stillbirth in women presenting with DFM and a live baby 40 .…”