Effect of encouraging awareness of reduced fetal movement and subsequent clinical management on pregnancy outcome: a systematic review and meta-analysis

HAYES, Mr. Dexter JL; DUMVILLE, Jo C; Walsh, Tim; Higgins, Lucy; Fisher, Margaret; Akselsson, Anna; Whitworth, Melissa; Heazell, Alexander

doi:10.1016/j.ajogmf.2022.100821

Cited by 4 publications

(8 citation statements)

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“…This is similar to other COSs used for women's and newborn health, 21 including recent COSs for studies of fetal growth restriction and pre‐eclampsia 20,22 . A systematic review of studies of interventions for RFM showed that not all of the outcomes selected for these COSs are measured routinely 15 . This Delphi process has shown that outcomes such as the acceptability of information about RFM and maternal knowledge of RFM are important to parents, clinicians and researchers from a range of backgrounds, and yet there are no established methods for measuring these outcomes.…”

Section: Resultssupporting

confidence: 54%

“…20,22 A systematic review of studies of interventions for RFM showed that not all of the outcomes selected for these COSs are measured routinely. 15 This Delphi process has shown that outcomes such as the acceptability of information about RFM and maternal knowledge of RFM are important to parents, clinicians and researchers from a range of backgrounds, and yet there are no established methods for measuring these outcomes. Only one published study to date has measured the acceptability of the information given to participants about RFM, 23 and, to our knowledge, none have quantified maternal knowledge of RFM in relation to an intervention.…”

Section: Resultsmentioning

confidence: 99%

“…13,14 A recent systematic review and meta-analysis showed that encouraging an awareness of fetal movement may be associated with a reduction in neonatal intensive care unit (NICU) admissions, low Apgar scores and reduced maternal anxiety, although the certainty of evidence and variation in outcome reporting impeded the analyses. 15 This review identified the need for core outcome sets (COSs) for studies relating to the awareness and the clinical management of RFM, to ensure that future studies all measure and report on outcomes that stakeholders consider most important, and to improve the consistency of outcome reporting for future syntheses of evidence.…”

Section: Studies Of Interventions For Reduced Fetal Movementmentioning

confidence: 99%

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Development of core outcome sets for studies relating to awareness and clinical management of reduced fetal movement

Hayes

Devane

Dumville

et al. 2023

BJOG

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ObjectiveThis study aimed to create core outcome sets (COSs) for use in research studies relating to the awareness and clinical management of reduced fetal movement (RFM).DesignDelphi survey and consensus process.SettingInternational.PopulationA total of 128 participants (40 parents, 19 researchers and 65 clinicians) from 16 countries.MethodsA systematic literature review was conducted to identify outcomes in studies of interventions relating to the awareness and the clinical management of RFM. Using these outcomes as a preliminary list, stakeholders rated the importance of these outcomes for inclusion in COSs for studies of: (i) awareness of RFM; and (ii) clinical management of RFM.Main outcome measuresPreliminary lists of outcomes were discussed at consensus meetings where two COSs (one for studies of RFM awareness and one for studies of clinical management of RFM).ResultsThe first round of the Delphi survey was completed by 128 participants, 66% of whom (n = 84) completed all three rounds. Fifty outcomes identified by the systematic review, after multiple definitions were combined, were voted on in round one. Two outcomes were added in round one, and as such 52 outcomes were voted on in two lists in rounds two and three. The COSs for studies of RFM awareness and clinical management are comprised of eight outcomes (four maternal and four neonatal) and 10 outcomes (two maternal and eight neonatal), respectively.ConclusionsThese COSs provide researchers with the minimum set of outcomes to be measured and reported in studies relating to the awareness and the clinical management of RFM.

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Section: Resultssupporting

confidence: 54%

Section: Resultsmentioning

confidence: 99%

Section: Studies Of Interventions For Reduced Fetal Movementmentioning

confidence: 99%

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Development of core outcome sets for studies relating to awareness and clinical management of reduced fetal movement

Hayes

Devane

Dumville

et al. 2023

BJOG

Self Cite

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“…A decrease in frequency of fetal movements is uncommon and associated with increased odds of stillbirth, particularly at earlier gestations 26 . At a population level, education around decreased fetal movements to pregnant women has not been shown to lower the risk of stillbirth, 27‐30 but it does reduce perinatal death, NICU admissions and Apgar scores <7 at 5 minutes of age 31 . Importantly, women presenting with decreased fetal movements continue to require attention, as there remains an association with SGA pregnancies, 30,32 planned early term birth, induction of labour and emergency caesarean section 32 …”

Section: Discussionmentioning

confidence: 99%

“…26 At a population level, education around decreased fetal movements to pregnant women has not been shown to lower the risk of stillbirth, [27][28][29][30] but it does reduce perinatal death, NICU admissions and Apgar scores <7 at 5 minutes of age. 31 Importantly, women presenting with decreased fetal movements continue to require attention, as there remains an association with SGA pregnancies, 30,32 planned early term birth, induction of labour and emergency caesarean section. 32 Our finding of an association between a single episode of vigorous fetal movements and stillbirth should be viewed with caution.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for late preterm and term stillbirth: A secondary analysis of an individual participant data meta‐analysis

Thompson

Wilson

et al. 2023

BJOG

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Objective: Identify independent and novel risk factors for late-preterm (28-36 weeks) and term (≥37 weeks) stillbirth and explore development of a risk-prediction model. Design: Secondary analysis of an Individual Participant Data (IPD) meta-analysis investigating modifiable stillbirth risk factors. Setting: An IPD database from five case-control studies in New Zealand, Australia, the UK and an international online study. Population: Women with late-stillbirth (cases, n = 851), and ongoing singleton pregnancies from 28 weeks' gestation (controls, n = 2257). Methods: Established and novel risk factors for late-preterm and term stillbirth underwent univariable and multivariable logistic regression modelling with multiple sensitivity analyses. Variables included maternal age, body mass index (BMI), parity, mental health, cigarette smoking, second-hand smoking, antenatal-care utilisation, and detailed fetal movement and sleep variables. Main outcome measures: Independent risk factors with adjusted odds ratios (aOR) for late-preterm and term stillbirth. Results: After model building, 575 late-stillbirth cases and 1541 controls from three contributing case-control studies were included. Risk factor estimates from separate multivariable models of late-preterm and term stillbirth were compared. As these were similar, the final model combined all late-stillbirths. The single multivariable model confirmed established demographic risk factors, but additionally showed that fetal movement changes had both increased (decreased frequency) and reduced (hiccoughs, increasing strength, frequency or vigorous fetal movements) aOR of stillbirth. Poor antenatal-care utilisation increased risk while more-than-adequate care was protective. The area-under-the-curve was 0.84 (95% CI 0.82-0.86). Conclusions: Similarities in risk factors for late-preterm and term stillbirth suggest the same approach for risk-assessment can be applied. Detailed fetal movement assessment and inclusion of antenatal-care utilisation could be valuable in latestillbirth risk assessment.

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Decreased fetal movements: Report from the International Stillbirth Alliance conference workshop

Bradford,

Hayes,

Damhuis

et al. 2023

Intl J Gynecology & Obste

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Maternal reports of decreased fetal movement (DFM) are a common reason to present to maternity care and are associated with stillbirth and other adverse outcomes. Promoting awareness of fetal movements and prompt assessment of DFM has been recommended to reduce stillbirths. However, evidence to guide clinical management of such presentations is limited. Educational approaches to increasing awareness of fetal movements in pregnant women and maternity care providers with the aim of reducing stillbirths have recently been evaluated in a several large clinical trials internationally. The International Stillbirth Alliance Virtual Conference in Sydney 2021 provided an opportunity for international experts in fetal movements to share reports on the findings of fetal movement awareness trials, consider evidence for biological mechanisms linking DFM and fetal death, appraise approaches to clinical assessment of DFM, and highlight research priorities in this area. Following this workshop summaries of the sessions prepared by the authors provide an overview of understandings of fetal movements in maternity care at the current time and highlights future directions in fetal movement research.

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Effect of encouraging awareness of reduced fetal movement and subsequent clinical management on pregnancy outcome: a systematic review and meta-analysis

Cited by 4 publications

References 51 publications

Development of core outcome sets for studies relating to awareness and clinical management of reduced fetal movement

Development of core outcome sets for studies relating to awareness and clinical management of reduced fetal movement

Risk factors for late preterm and term stillbirth: A secondary analysis of an individual participant data meta‐analysis

Decreased fetal movements: Report from the International Stillbirth Alliance conference workshop

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