My Baby’s Movements: a stepped wedge cluster randomised controlled trial to raise maternal awareness of fetal movements during pregnancy study protocol

Flenady, Vicki; Gardener, Glenn; Boyle, F. M.; Callander, Emily; Coory, Michael; East, Christine; Ellwood, David; Gordon, Adrienne; Groom, K. M.; Middleton, Philippa; Norman, Jane E.; Warrilow, Kara; Weller, Megan; Wojcieszek, Aleena M; Crowther, Caroline A

doi:10.1186/s12884-019-2575-1

Cited by 20 publications

(22 citation statements)

References 53 publications

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“…The reasons we did not find an association between DFM and stillbirth may include a change in practice (in line with institutional guidelines and policies), heightened clinician and community awareness of the potential for adverse outcomes associated with DFM, and participation in the My Baby's Movements' trial. 36 These factors resulted in higher rates of planned early term birth, which clearly resulted in increased live births. However, in our analysis of data from before and after the introduction of these guidelines, we did not find significant differences in stillbirth rates.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Pregnancy Outcomes Among Women With Decreased Fetal Movements

et al. 2021

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IMPORTANCE Stillbirth is a devastating pregnancy outcome with far-reaching economic and psychosocial consequences, but despite significant investment, a screening tool for identifying those fetuses at risk for stillbirth remains elusive. Maternal reporting of decreased fetal movements (DFM) has been found to be associated with stillbirth and other adverse perinatal outcomes. OBJECTIVETo examine pregnancy outcomes of women presenting with DFM in the third trimester at a tertiary Australian center with a clear clinical management algorithm. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data on all births meeting the inclusion criteria from 2009 through 2019 at Mater Mothers' Hospital in Brisbane, Australia. This is a tertiary center and Australia's largest maternity hospital. All singleton births without a known congenital anomaly after 28 weeks' gestation were included. Among 203 071 potential participants identified from the hospital database, 101 597 individuals met the eligibility criteria. Data analysis was performed from May through September 2020. EXPOSURE Presentation to hospital with DFM after 28 weeks gestation. MAIN OUTCOMES AND MEASURES The primary outcome of this study was the incidence of stillbirth. Multivariate analysis was undertaken to determine the association between DFM and stillbirth, obstetric intervention, and other adverse outcomes, including being born small for gestational age (SGA) and a composite adverse perinatal outcome (at least 1 of the following: neonatal intensive care unit admission, severe acidosis [ie, umbilical artery pH <7.0 or base excess −12.0 mmol/L or less], 5-minute Apgar score <4, or stillbirth or neonatal death). The hypothesis being tested was formulated prior to data collection. RESULTS Among 101 597 women with pregnancies that met the inclusion criteria, 8821 (8.7%) presented at least once with DFM and 92 776 women (91.3%) did not present with DFM (ie, the control population). Women presenting with DFM, compared with those presenting without DFM, were younger (mean [SD] age, 30.4 [5.4] years vs 31.5 [5.2] years; P < .001), more likely to be nulliparous (4845 women [54.9%] vs 42 210 women [45.5%]; P < .001) and have a previous stillbirth (189 women [2.1%] vs 1156 women [1.2%]; P < .001), and less likely to have a previous cesarean delivery (1199 women [13.6%] vs 17 444 women [18.8%]; P < .001). During the study period, the stillbirth rate was 2.0 per 1000 births after 28 weeks' gestation. Presenting with DFM was not associated with higher odds of stillbirth (9 women [0.1%] vs 185 women [0.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Pregnancy Outcomes Among Women With Decreased Fetal Movements

et al. 2021

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“…It is worthwhile to note that the results of this study may be impacted by other concurrent events, such as a Senate inquiry into stillbirth research and education, and media coverage of the stillbirth experienced by a famous footballer's partner. In addition, the My Baby's Movement intervention, which comprised of a mobile phone application and educational program for clinicians, 22 was launched during the Movements Matter campaign.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Movements Matter: A social media and hospital‐based campaign aimed at raising awareness of decreased fetal movements

Chan

Gordon

Warrilow

et al. 2021

Aust NZ J Obst Gynaeco

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Background:The Movements Matter campaign aimed to raise awareness of decreased fetal movements (DFM) among pregnant women and inform clinicians of best practice management. Aim:To conduct a process evaluation of campaign implementation, and an impact evaluation of the campaign's effects on knowledge and experiences of pregnant women, and attitudes and practices of clinicians in relation to DFM. Methods:This study used a cross-sectional before-after design. Pregnant women and clinicians were sampled at five hospitals. Women were surveyed about their knowledge of DFM, and actions to take if they noticed DFM. Clinicians were asked about their current practices and attitudes about informing women about DFM.Logistic regression was used to calculate campaign effects on outcome measures. Results:The Movements Matter campaign reached 653 262 people on social media, as well as being covered on news media and popular women's websites. The evaluation surveyed 1142 pregnant women pre-campaign and 473 post-campaign, and 372 clinicians pre-campaign and 149 post-campaign. Following the campaign, women were more likely to be aware that babies should move the same amount in late pregnancy (adjusted odds ratio (aOR) 1.81, 95% CI 1.43-2.27), and were more likely to contact their health service immediately if their baby was moving less (aOR 1.52, 95% CI 1.22-1.91). Clinicians were 2.84 times more likely to recommend women should come in for assessment if they experience DFM (95% CI 1. 35-5.97). Conclusions:This evaluation has shown that a campaign using social media and in-hospital education materials led to some increases in knowledge about fetal movements among pregnant women.

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“…15 However, there is a wide variation in the management of RFM despite the guidelines partly due to nonspecific nature of RFM, lack of standardized predictive tests, and lack of high-quality evidence in management. 16 There are two major ambiguities about management of RFM: first, awareness, counting and reporting of the symptom that is currently being investigated by some major ongoing trails like My Baby's Movements trial in Australia and New Zealand, 17 and the Mindfetalness study in Sweden in addition to the AFFIRM trial that showed no positive impact recently. 7,18 Second, there is no precise diagnostic test that can pick up those patients who are likely to have a poor perinatal outcome among those who present with RFM.…”

Section: Discussionmentioning

confidence: 99%

An emerging method in evaluation of reduced fetal movements using cerebroplacental ratio: A prospective case–control study

Inukollu

Sulthana

Solipuram

et al. 2021

J of Obstet and Gynaecol

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Aim: Nearly half of the patients with stillbirths experience reduced fetal movements (RFM) in the preceding week. The standardized evaluation will help reduce stillbirths. Placental dysfunction is the underlying pathophysiology for RFM and low cerebroplacental ratio (CPR). We attempted to determine the application of CPR in evaluation of RFM. Methods: A prospective case-control study with 100 patients each of cases and controls were studied at a tertiary care hospital. Middle cerebral artery pulsatility index (MCA-PI), umbilical artery PI (UA-PI), and CPR were calculated as multiples of median (MoM) in patients presenting with RFM after 30 weeks and their matched controls and followed up. CPR values of various gestation ranges and single versus multiple episodes of RFM were analyzed. Results: Compared to controls, women with RFM showed a significantly low MCA PI MoM (0.94 vs 1.4; p = 0.00008) and low CPR MoM (1.48 vs 1.6; p = 0.015). Women with multiple RFM episodes had lower CPR MoM (1.2 vs 1.5; p < 0.00001) compared to single episode RFM. Multiple RFM episode patients had low MCA PI MoM (1.3 vs 1.4; p = 0.0038) and low CPR MoM (1.2 vs 1.6; p < 0.00001) compared to controls. There was a significantly low CPR in 32-34 weeks (1.35 vs 1.81; p = 0.004) and 36-38 weeks subgroups (1.39 vs 1.58; p = 0.002). No significant difference in birthweight centiles or AGA versus SGA categories between cases and controls was noted questioning current guidelines where ultrasound evaluation is done for RFM patients with FGR. Conclusion: Incorporation of routine CPR measurements can standardize evaluation of RFM patients, especially those with AGA to pick up patients at risk of poor outcome and bring down stillbirth rates.

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My Baby’s Movements: a stepped wedge cluster randomised controlled trial to raise maternal awareness of fetal movements during pregnancy study protocol

Cited by 20 publications

References 53 publications

Evaluation of Pregnancy Outcomes Among Women With Decreased Fetal Movements

Evaluation of Pregnancy Outcomes Among Women With Decreased Fetal Movements

Evaluation of Movements Matter: A social media and hospital‐based campaign aimed at raising awareness of decreased fetal movements

An emerging method in evaluation of reduced fetal movements using cerebroplacental ratio: A prospective case–control study

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