Fetal Movement Counting and Perinatal Mortality

Bellussi, Federica; Po, Gaia; Livi, Alessandra; Saccone, Gabriele; Vivo, Valentino De; Oliver, Emily A.; Berghella, Vincenzo

doi:10.1097/aog.0000000000003645

Cited by 50 publications

(53 citation statements)

References 18 publications

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“…The participants of one study contributed to 82% of the total number of participants across all studies included in the review, which the authors regarded as a limitation. A comparison of the Mindfetalness-trial with the results of this review is difficult, as our study design and the concept "awareness of fetal movements" differs from those of the studies included in the article by Belussi et al [16].…”

Section: Discussionmentioning

confidence: 87%

“…Taken together, the results of the AFFIRM study, our study, and the one conducted by Tveit and co-workers [15], do not support concerns that increased awareness of fetal movements causes harm. Additionally, in a recent systematic review and meta-analysis investigating the effect of fetal movement counting in perinatal mortality and obstetric outcomes, an 8 % reduction in perinatal mortality was seen in the fetal movement counting group (CI 0.85-1.00) [16]. The rate of labor induction and cesarean section was somewhat higher in the counting group.…”

Section: Discussionmentioning

confidence: 98%

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A decrease in cesarean sections and labor inductions among Swedish women by awareness of fetal movements with the Mindfetalness method

Akselsson

Lindgren

Skokic

et al. 2020

BMC Pregnancy Childbirth

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Background Maternal perception of decreased fetal movements is commonly used to assess fetal well-being. However, there are different opinions on whether healthcare professionals should encourage maternal observation of fetal movements, as researchers claim that raising awareness increases unnecessary interventions, without improving perinatal health. We aimed to investigate whether cesarean sections and labor induction increase by raising women’s awareness of fetal movements through Mindfetalness. Further, we aimed to study perinatal health after implementing Mindfetalness in maternity care. Methods In a cluster randomized controlled trial, 67 maternity clinics were allocated to Mindfetalness or routine care. In the Mindfetalness group, midwives distributed a leaflet telling the women to focus on the character, strength and frequency of the fetal movements without counting each movement. The instruction was to do so for 15 min daily when the fetus was awake, from gestational week 28 until birth. In this sub-group analysis, we targeted women born in Sweden giving birth from 32 weeks’ gestation. We applied the intention-to-treat principle. Results The Mindfetalness group included 13,029 women and the Routine-care group 13,456 women. Women randomized to Mindfetalness had less cesarean sections (18.4% vs. 20.0%, RR 0.92, CI 0.87–0.97) and labor inductions (19.2% vs. 20.3%, RR 0.95, CI 0.90–0.99) compared to the women in the Routine-care group. Less babies were born small for gestational age (8.5% vs. 9.3%, RR 0.91, CI 0.85–0.99) in the Mindfetalness group. Women in the Mindfetalness group contacted healthcare due to decreased fetal movements to a higher extent than women in the Routine care group (7.8% vs. 4.3%, RR 1.79, CI 1.62–1.97). The differences remain after adjustment for potential confounders. Conclusions Raising awareness about fetal movements through Mindfetalness decreased the rate of cesarean sections, labor inductions and small-for-gestational age babies. Trial registration ClinicalTrials.gov (NCT02865759). Registered 12 August 2016, www.clinicaltrials.gov.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 98%

A decrease in cesarean sections and labor inductions among Swedish women by awareness of fetal movements with the Mindfetalness method

Akselsson

Lindgren

Skokic

et al. 2020

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

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“…Evidence for the effectiveness of objective FM monitoring methods for improving perinatal outcome however is lacking. A recent systematic review and meta-analysis comparing perinatal outcomes in women instructed to count their FMs compared to no counting instructions found no difference between the groups in the incidence of perinatal death or morbidity [11]. The large AFFIRM trial, however, contributed most of the data to the meta-analyses in this review.…”

Section: Introductionmentioning

confidence: 81%

Assessing fetal movements in pregnancy: A qualitative evidence synthesis of women’s views, perspectives and experiences

Smith

Muldoon

Brady

et al. 2021

BMC Pregnancy Childbirth

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Background Raising awareness of the importance of fetal movements (FMs) and advising women on the appropriate action to take if they experience reduced FMs, is important for minimising or avoiding adverse perinatal outcomes. To gain insight and understanding of women’s perspectives of assessing FMs in pregnancy, we conducted a qualitative evidence synthesis. Methods A qualitative evidence synthesis using thematic synthesis was conducted. Studies were eligible if they included pregnant women who were at least 20 weeks gestation and reported qualitative data from women on assessing FMs in pregnancy. MEDLINE, CINAHL, EMBASE, PsycINFO and Social Science Citation Index, from inception to July 2020, were searched. The methodological quality of included studies was assessed by at least two reviewers using an Evidence for Policy and Practice Information (EPPI)-Centre quality assessment tool. Data synthesis, using the Thomas and Harden framework, involved line by line coding of extracted data, establishing descriptive themes, and determining analytical themes. Confidence in the findings was assessed using GRADE CER-Qual. Results Nine studies, involving 2193 women, were included in the review. The methodological quality of the studies was overall generally high. The synthesis revealed three dominant themes, and seven sub-themes that reflected women’s perspectives of assessing FMs in pregnancy. These were; 1) How women engage with FMs, with subthemes of informal engagement, formal engagement, and strategies to stimulate FMs; 2) ‘ … like a feather inside my belly’ - articulating and describing FMs, with sub-themes of sensations associated with FMs and timing and frequency of FMs; and 3) FMs and help/health seeking, with sub-themes of information sources and interacting with healthcare professionals. Confidence in the findings was either high or moderate, although two findings were rated low confidence and one very low. Conclusion This qualitative evidence synthesis reveals that women informally engage with FMs during pregnancy. Women commonly adopt strategies to stimulate FMs when concerned. The use of the internet was a common source of obtaining information regarding FMs. Women require better support when contacting healthcare professionals about FMs. As only three of the nine included studies were exclusively qualitative in design, further qualitative studies exploring women’s perspective of assessing FMs in pregnancy are required.

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“…Contrastingly, several women were happy to complete kick charts, and felt that they helped them get to know their baby's pattern of movement. This nding should be considered in the context of limited available evidence on the effectiveness of objective FM assessment methods in reducing perinatal adversity [10][11][12] balanced with evidence of the bene ts for increased maternal-fetal attachment [13][14][15]. This is coupled with the evidence supporting the use of formal FM assessment in assisting women get to know their baby's individual FM pattern.…”

Section: Discussionmentioning

confidence: 99%

“…perinatal outcome however is lacking. A recent systematic review and meta-analysis comparing perinatal outcomes in women instructed to count their FMs compared to no counting instructions found no difference between the groups in the incidence of perinatal death or morbidity [10]. Similarly, the large AFFIRM study, involving 409175 pregnancies of which 227860 births occurred during the intervention period, also found no difference between the groups in stillbirth rates although the intervention group had higher caesarean section rates [11].…”

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confidence: 99%

Assessing Fetal Movements in Pregnancy: A Qualitative Evidence Synthesis of Women’s Views, Perspectives and Experiences

Smith

Muldoon

Brady

et al. 2020

Preprint

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Background: Raising awareness of the importance of fetal movements (FMs) and advising women on the appropriate action to take if they experience reduced FMs, is critical for minimising or avoiding adverse perinatal outcomes. To gain insight and understanding of women’s perspectives of assessing FMs in pregnancy, we conducted a qualitative evidence synthesis. Methods: A qualitative evidence synthesis using thematic synthesis was conducted. Studies were eligible if they included pregnant women who were at least 20 weeks gestation and reported qualitative data from women on assessing FMs in pregnancy. MEDLINE, CINAHL, EMBASE, PsycINFO and Social Science Citation Index, from inception to July 2020, were searched. The methodological quality of included studies was assessed by at least two reviewers using an EPPI-Centre quality assessment tool. Data analysis, using the Thomas and Harden framework, involved line by line coding of extracted data, establishing descriptive themes, and determining analytical themes. Confidence in the findings was assessed using GRADE CER-Qual. Results: Nine studies, involving 2193 women, were included in the review. The methodological quality of the studies was overall generally high. The synthesis revealed three dominant themes, and seven sub-themes that reflected women’s perspectives of assessing FMs in pregnancy. These were; 1) How women engage with FMs, with subthemes of informal engagement, formal engagement, and strategies to stimulate FMs; 2) ‘…like a feather inside my belly’ - articulating and describing FMs, with sub-themes of sensations associated with FMs and timing and frequency of FMs; and 3) FMs and help/health seeking, with sub-themes of information sources and interacting with healthcare professionals. Confidence in the findings was either high or moderate, although two findings were rated low confidence and one very low.Conclusion: This qualitative evidence synthesis reveals that women informally engage with FMs during pregnancy. Women commonly adopt strategies to stimulate FMs when concerned. The use of the internet was a common source of obtaining information regarding FMS. Women require better support when contacting healthcare professionals about FMs. As only three of the nine included studies were exclusively qualitative in design, further qualitative studies exploring women’s perspective of assessing FMs in pregnancy are required.

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Fetal Movement Counting and Perinatal Mortality

Abstract: Personal or nonessential information may be redacted at the editor's discretion.

Cited by 50 publications

References 18 publications

A decrease in cesarean sections and labor inductions among Swedish women by awareness of fetal movements with the Mindfetalness method

A decrease in cesarean sections and labor inductions among Swedish women by awareness of fetal movements with the Mindfetalness method

Assessing fetal movements in pregnancy: A qualitative evidence synthesis of women’s views, perspectives and experiences

Assessing Fetal Movements in Pregnancy: A Qualitative Evidence Synthesis of Women’s Views, Perspectives and Experiences

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