Being aware of fetal movement doesn't prevent stillbirths

[October 09, 2018]  By Anne Harding

(Reuters Health) - Encouraging pregnant women to be aware of reduced fetal movement and to report it promptly to their doctors does not reduce stillbirth risk, new findings show.

"We cannot rely on reduced fetal movement awareness as a strategy to reduce stillbirth," Dr. Jane E. Norman of Queen's Medical Research Institute in Edinburgh, the study's first author, told Reuters Health via email.

Stillbirth prevention programs often advise pregnant women to beware of reduced fetal movement, despite the lack of evidence that such monitoring reduces stillbirth risk.

Norman's team evaluated this approach in a trial at 33 hospitals in the UK and Ireland. The researchers provided an online learning package to doctors on management of reduced fetal movement. They also provided a leaflet about monitoring fetal movements to women who were about 20 weeks pregnant. The pamphlet instructed women to monitor changes in fetal movements starting at 24 weeks, and to seek immediate care if they observe changes after 28 weeks' gestation.

Between 2014 and 2016, the authors collected data on 157,692 pregnancies from before the introduction of the learning package and 227,860 after the learning package was in use.

For every 1,000 pregnancies, there were roughly four stillbirths at or past 24 weeks, with or without the special advice to monitor fetal movements.

Women who detect reduced fetal movement should still seek advice from their doctor or midwife, Norman told Reuters Health.

But, she added, on its own, teaching women to be aware of reduced fetal movement cannot be recommended as an effective way to reduce stillbirth.

To date, an association between stillbirth and reduced fetal movement has not been proved, Dr. Kate F. Walker and Dr. Jim G. Thornton of the University of Nottingham in the UK note in a comment published with the study in The Lancet.

Given the size of the study, and the fact that the findings align with another large trial that looked at monitoring fetal movement for stillbirth prevention, experts "need to consider how current guidelines might be revised," they say.

"Discouraging campaigns that promote awareness preterm, improving (guidelines for induction of labor), and not inducing delivery in response to perception of altered movement alone would seem to be sensible first steps," they conclude.

SOURCE: http://bit.ly/2yprBBV and http://bit.ly/2yjnh7g The Lancet, online September 27, 2018.

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