Fetal movements in stillbirth prevention

Fetal movements in stillbirth prevention

Beatriz Arrabal Delgado (1), Maria Teresa Rivas Castillo (2), Encarnación Martinez Garcia (3)

(1) Midwife, Hospital Materno-Infantil Virgen de las Nieves, Granada, Spain; (2) Midwife, Hospital de Motril, Granada, Spain; (3) Midwife, Hospital de Guadix, Granada, Spain

Background:
Maternal perception of fetal movement is one of the first signs of fetal life and is regarded as a manifestation of fetal wellbeing. A significant reduction or sudden alteration in fetal movement is a potentially important clinical sign. It has been suggested that reduced or absent fetal movements may be a warning sign of impending fetal death. Raising awareness among pregnant women of the importance of detecting and reporting reduced fetal movement (RFM) and ensuring providers have protocols in place, based on best available evidence, to manage care for women who report RFM are one of the four lines of action proposed by the “Saving babies lives” guidance to prevent Stillbirth. At present timely delivery is the only strategy to prevent stillbirth in response to concerns about fetal wellbeing. The objective of this study is to review the latest evidence about fetal movements in stillbirth prevention.

Methods:
Systematic review in database: Cuiden, PubMed, Cochrane, Medline and Google academic
Search strategy: publiced in the last 5 years, free full text available, according to my search topic, English or Spanish. Key words: “fetal movements” (movimientos fetales) – “perinatal death” (muerte perinatal) – stillbirth (muerte fetal)

Results:
RFM is only modestly associated with increased risk of stillbirth and whether RFM is a symptom of inevitable fetal death or whether it can be used as an alert to prompt action and improve outcome is unclear. Encouraging awareness of fetal movements it may be harmful. Stillbirths were not significantly reduced by this intervention and there was no effect on perinatal mortality. Current evidence regarding excessive fetal movements is sparse.

Conclusions:
Information that women receive about the importance of fetal movements and what to do if there are changes is inconsistent and may not be evidence based. Awareness of reduced fetal movement (RFM) is promoted to reduce stillbirth, but the evidence to support the effect of RFM awareness is uncertain. It is important that midwives know the evidence in order to deliver consistent information to women in their care. There is no evidence that any formal definition of RFM is of greater value than the subjective maternal perception in the detection of fetal compromise. This study highlights the need for continued research, education and training in the identification, investigation and management of RFM. Further research is needed to clarify optimum management strategies to optimise maternal and fetal outcome.

Ethics statement:
Ethical approval was not sought as it was not required for this study. The authors have stated explicitly that there are no conflicts of interest in connection with this article, neither external funding.

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