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Frederik J Froen - One of the best experts on this subject based on the ideXlab platform.
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Predictors of Poor Perinatal Outcome following Maternal Perception of Reduced Fetal Movements – A Prospective Cohort Study
2016Co-Authors: Philip J. Dutton, Lynne K. Warr, Stephen A. Roberts, Giovanna Bernatavicius, Louise M. Byrd, David Gaze, Josh Kroll, Rebecca L. Jones, Colin P. Sibley, Frederik J FroenAbstract:Background: Maternal Perception of reduced fetal movement (RFM) is associated with increased risk of stillbirth and fetal growth restriction (FGR). RFM is thought to represent fetal compensation to conserve energy due to insufficient oxygen and nutrient transfer resulting from placental insufficiency. Objective: To identify predictors of poor perinatal outcome after Maternal Perception of reduced fetal movements (RFM). Design: Prospective cohort study. Methods: 305 women presenting with RFM after 28 weeks of gestation were recruited. Demographic factors and clinical history were recorded and ultrasound performed to assess fetal biometry, liquor volume and umbilical artery Doppler. A Maternal serum sample was obtained for measurement of placentally-derived or modified proteins including: alpha fetoprotein (AFP), human chorionic gonadotrophin (hCG), human placental lactogen (hPL), ischaemia-modified albumin (IMA), pregnancy associated plasma protein A (PAPP-A) and progesterone. Factors related to poor perinatal outcome were determined by logistic regression. Results: 22.1 % of pregnancies ended in a poor perinatal outcome after RFM. The most common complication was small-for-gestational age infants. Pregnancy outcome after Maternal Perception of RFM was related to amount of fetal activity while being monitored, abnormal fetal heart rate trace, diastolic blood pressure, estimated fetal weight, liquor volume, serum hC
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fetal movement assessment
Seminars in Perinatology, 2008Co-Authors: Frederik J Froen, Alexander E P Heazell, Julie Victoria Holm Tveit, Eli Saastad, Ruth C Fretts, Vicki FlenadyAbstract:Maternal Perception of fetal movements is the oldest and most commonly used method to assess fetal well-being. While almost all pregnant women adhere to it, organized screening by fetal movements has seen variable popularity among health professionals. Early results of screening were promising and fetal movement counting is the only antepartum testing method that has shown effect in reducing mortality in a randomized controlled trial comparing testing versus no testing. Although awareness of fetal movements is associated with improved perinatal outcomes, the quest to define a quantitative "alarm limit" to define decreased fetal movements has so far been unsuccessful, and the use of most such limits developed for fetal movement counting should be discouraged.
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midwives and obstetricians knowledge and management of women presenting with decreased fetal movements
Acta Obstetricia et Gynecologica Scandinavica, 2008Co-Authors: Alexander E P Heazell, Frederik J Froen, Vicki Flenady, Matthew Green, Caroline WrightAbstract:Background. Maternal Perception of decreased fetal movements (DFM) affects 5-15% of pregnancies. DFM is associated with intra-uterine fetal death (IUFD) and intra-uterine growth restriction (IUGR). It has been proposed that Maternal Perception of DFM may be used as a screening tool for IUFD or IUGR. However, this proposal is complicated by variations in definitions and management of DFM. Hypothesis. We hypothesised that uncertainties in the definition and management of women presenting with DFM leads to variation in clinical practice. Methods. A postal questionnaire was sent to midwives and consultant obstetricians in the UK. Results. The majority of respondents enquired about the presence of fetal movements after 28 weeks gestation. There was little agreement on a definition of DFM, with a Maternal Perception of decreased movements for 24 h gaining the greatest acceptance. Few practitioners used formal fetal movement counting, with the majority of respondents stating they were ineffective in the prevention of IUGR or IUFD and led to increased intervention. There was large variation in the knowledge of associations with DFM and management of women presenting with DFM. Conclusions. There were wide variations in the practice of obstetricians and midwives with regard to women presenting with DFM; many aspects of practice were not based on the available evidence. The variation in practice may result from a lack of robust evidence on which to base the provision of care. Further research is needed to provide and disseminate evidence to direct the management of women presenting with DFM.
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a kick from within fetal movement counting and the cancelled progress in antenatal care
Journal of Perinatal Medicine, 2004Co-Authors: Frederik J FroenAbstract:Interest for Maternal fetal movement counting as a method of screening for fetal well-being boomed during the 1970's and 1980's. Several reports demonstrated that the introduction of counting charts significantly reduced stillbirth rates. However, in 1989, a large study appeared in The Lancet that annihilated research in this field by deeming charts ineffective. In retrospect, it seems evidence was lacking. This review revisits the subject of the significance of fetal movement counting in predicting outcome and reducing stillbirth rates. A structured search was performed to identify studies relating to pregnancy outcome and its association with Maternal Perception of fetal movements. Suspected preliminary or redundant material was excluded. Only publications from Western countries dating from after 1970 were included. Twenty-four studies were identified. Available data demonstrate that reduced fetal movements are associated with adverse pregnancy outcome, both in high and low risk pregnancies. Increased vigilance towards Maternal Perception of movements (e.g. by performing movement counting studies) reduces stillbirth rates, in particular stillbirths deemed avoidable. While screening for fetal well-being by Maternal fetal movement counting can reduce fetal mortality rates, a resurrection in research activity is urgently needed to optimize its benefits.
Alexander E P Heazell - One of the best experts on this subject based on the ideXlab platform.
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Placental PHLDA2 expression is increased in cases of fetal growth restriction following reduced fetal movements
2020Co-Authors: Anna Bugge Janssen, Alexander E P Heazell, Simon J Tunster, Rosalind M JohnAbstract:Abstract Background: Maternal Perception of reduced fetal movements (RFM) is associated with increased risk of fetal growth restriction (FGR) and stillbirth, mediated by placental insufficiency. The Maternally expressed imprinted gene PHLDA2 controls fetal growth, placental development and placental lactogen production in a mouse model. A number of studies have also demonstrated abnormally elevated placental PHLDA2 expression in human growth restricted pregnancies. This study examined whether PHLDA2 was aberrantly expressed in placentas of RFM pregnancies resulting in delivery of an FGR infant and explored a possible relationship between PHLDA2 expression and placental lactogen release from the human placenta. Methods: Villous trophoblast samples were obtained from a cohort of women reporting RFM (N = 109) and PHLDA2 gene expression analysed. hPL levels were assayed in the Maternal serum (N = 74)
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reduced fetal movement intervention trial 2 remit 2 protocol for a pilot randomised controlled trial of standard care informed by the result of a placental growth factor plgf blood test versus standard care alone in women presenting with reduced feta
Trials, 2018Co-Authors: Lindsay Armstrongbuisseret, Alexander E P Heazell, J G Thornton, Eleanor J Mitchell, Trish Hepburn, Lelia Duley, Tracy E Roberts, C Storey, Rebecca SmythAbstract:Forty percent of babies who are stillborn born die after 36 weeks gestation and have no lethal structural abnormality. Maternal Perception of reduced fetal movement (RFM) is associated with stillbirth and is related to abnormal placental structure and function. The ultimate objective of this trial is to assess whether for women with RFM, intervention directed by measurement of placental biochemical factors in addition to standard care improves pregnancy outcome compared with standard care alone. This is the protocol for a pilot trial to determine the feasibility of a definitive trial and also provide proof of concept that informing care by measurement of placental factors improves neonatal outcomes. ReMIT-2 is a multicentre, pilot randomised controlled trial of care informed by results of an additional placental factor blood test versus standard care alone for women presenting with RFM at or after 36+ 0 weeks gestation. Participants will be randomised 1:1 to the intervention arm where the blood test result is revealed and acted on, or to the control arm where the blood sample is not tested immediately and therefore the result cannot be acted on. All participants will be followed up six weeks after delivery to assess their health status and views of the trial, along with healthcare costs. A sub-group will be interviewed within 16 weeks after delivery to further explore their views of the trial. Outcomes to determine feasibility of a definitive trial include number of potentially eligible women, proportion lost to follow-up, clinical characteristics at randomisation, reasons for non-recruitment, compliance with the trial intervention and views of participants and clinicians about the trial. Proof of concept outcomes include: rates of induction of labour; Caesarean birth; and a composite neonatal outcome of stillbirths and deaths before discharge, 5-min Apgar score 48 h. Results from this pilot trial will help determine whether a large definitive trial is feasible. Such a study would provide evidence to guide management of women with RFM and reduce stillbirths. ISRCTN Registry, ISRCTN12067514 . Registered on 8 September 2017.
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alterations in Maternally perceived fetal movement and their association with late stillbirth findings from the midland and north of england stillbirth case control study
BMJ Open, 2018Co-Authors: Alexander E P Heazell, Billie Bradford, Robin S Cronin, Lesley M E Mccowan, Jayne Budd, Edwin A Mitchell, Tomasina Stacey, Bill Martin, Devender Roberts, John M D ThompsonAbstract:Objective To report Perception of fetal movements in women who experienced a stillbirth compared with controls at a similar gestation with a live birth. Design Case–control study. Setting 41 maternity units in the UK. Participants Cases were women who had a late stillbirth ≥28 weeks gestation (n=291) and controls were women with an ongoing pregnancy at the time of the interview (n=733). Controls were frequency matched to cases by obstetric unit and gestational age. Methods Data were collected using an interviewer-administered questionnaire which included questions on Maternal Perception of fetal movement (frequency, strength, increased and decreased movements and hiccups) in the 2 weeks before the interview/stillbirth. Five fetal movement patterns were identified incorporating the changes in strength and frequency in the last 2 weeks by combining groups of similar pattern and risk. Multivariable analysis adjusted for known confounders. Primary outcome measure Association of Maternally perceived fetal movements in relation to late stillbirth. Results In multivariable analyses, women who reported increased strength of movements in the last 2 weeks had decreased risk of late stillbirth compared with those whose movements were unchanged (adjusted OR (aOR) 0.18, 95% CI 0.13 to 0.26). Women with decreased frequency (without increase in strength) of fetal movements were at increased risk (aOR 4.51, 95% CI 2.38 to 8.55). Daily Perception of fetal hiccups was protective (aOR 0.31, 95% CI 0.17 to 0.56). Conclusions Increased strength of fetal movements and fetal hiccups is associated with decreased risk of stillbirth. Alterations in frequency of fetal movements are important in identifying pregnancies at increased risk of stillbirth, with the greatest risk in women noting a reduction in fetal activity. Clinical guidance should be updated to reflect that increase in strength and frequency of fetal movements is associated with the lowest risk of stillbirth, and that decreased fetal movements are associated with stillbirth. Trial registration number NCT02025530.
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Maternal Perception of fetal movements in late pregnancy is affected by type and duration of fetal movement
Journal of Maternal-fetal & Neonatal Medicine, 2016Co-Authors: Rebecca Brown, Lucy Higgins, Edward Johnstone, Jayawan H B Wijekoon, Alexander E P HeazellAbstract:AbstractObjective: A reduction in fetal movements has been proposed to identify pregnancies at risk of stillbirth. The utility of this approach is limited by variability in Maternal Perception of fetal movements. We aimed to determine the proportion of fetal movements observed by ultrasound that were Maternally perceived and identify factors that affected Maternal Perception.Method: During 30-min recordings, women (n = 21) depressed a trigger upon Perception of a fetal movement, while an ultrasound operator recorded observed movements according to the fetal parts involved.Results: Women perceived between 2.4% and 81.0% (median 44.8%) of movements observed on scan. Synchronous movement of the fetal trunk and limbs was more likely to be recognized than either part in isolation (60.5% versus 37.5% and 30%, respectively). The ultrasound operator judged the fetus to be moving for a significantly greater proportion of the time than mothers (median 1.5% of total recording time versus 0.7%). There was no signific...
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fetal movement assessment
Seminars in Perinatology, 2008Co-Authors: Frederik J Froen, Alexander E P Heazell, Julie Victoria Holm Tveit, Eli Saastad, Ruth C Fretts, Vicki FlenadyAbstract:Maternal Perception of fetal movements is the oldest and most commonly used method to assess fetal well-being. While almost all pregnant women adhere to it, organized screening by fetal movements has seen variable popularity among health professionals. Early results of screening were promising and fetal movement counting is the only antepartum testing method that has shown effect in reducing mortality in a randomized controlled trial comparing testing versus no testing. Although awareness of fetal movements is associated with improved perinatal outcomes, the quest to define a quantitative "alarm limit" to define decreased fetal movements has so far been unsuccessful, and the use of most such limits developed for fetal movement counting should be discouraged.
Vicki Flenady - One of the best experts on this subject based on the ideXlab platform.
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my baby s movements a stepped wedge cluster randomised controlled trial of a fetal movement awareness intervention to reduce stillbirths
2021Co-Authors: Vicki Flenady, Glenn Gardener, David Ellwood, Michael Coory, Megan Weller, Kara Warrilow, Philippa Middleton, Aleena M Wojcieszek, Katie M Groom, Frances M BoyleAbstract:Background: Maternal Perception of decreased fetal movements (DFM) is associated with stillbirth. The My Baby’s Movements (MBM) trial aimed to evaluate the impact on stillbirth rates of a multifaceted awareness package for women and clinicians. Methods: A stepped wedge cluster randomised controlled trial was undertaken with 8 groups of 3-5 hospitals in Australia and New Zealand at four-monthly intervals, targeting women with a singleton pregnancy without major fetal anomaly at ≥28 weeks’ gestation. The primary outcome was stillbirth at ≥28 weeks’ gestation. Secondary outcomes included obstetric and neonatal outcomes. Analysis was undertaken using generalised linear mixed models controlling for calendar time, clustering, and hospital effects. Findings: From August 2016 to May 2019 there were 304,853 births with 290,219 meeting inclusion criteria: 150,079 in control and 140,140 in intervention periods. The stillbirth rate during the intervention was lower than the control period, although not statistically significant (2·2/1000 births versus 2·4, odds ratio [OR] 0·91, 95% Confidence Intervals [CI] 0·78-1·06, p=0·22). The decrease was larger across calendar time with 2·7/1000 in the first 18 months versus 2·0/1000 in the last 18 months (OR 0·74; 95% CI 0·63-0·86; p≤0·01). Adjusting for calendar time, stillbirth rates between the control and intervention periods were not significantly different: (aOR 1·18, 95% CI 0·93-1·50; p=0·18). No increase in obstetric intervention or adverse neonatal outcome was evident. Interpretation: The MBM intervention did not reduce stillbirths beyond the downward trend over time, suggesting hospitals may have implemented best practice in DFM management outside their randomisation schedule. Based on these findings, the role of interventions for raising awareness of DFM remains unclear. Trial Registration: ACTRN12614000291684. Funding Statement: National Health and Medical Research Council (NHMRC) Project Grant Application (APP1067363). Stillbirth Foundation Australia provided funding to develop the MBM application. Dr Glenn Gardener was provided a Betty McGrath Fellowship through the Mater Research Institute. Additional support was provided by Mater Foundation and the NHMRC Stillbirth Centre of Research Excellence. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: Primary ethics approval was obtained from Mater Misericordiae Ltd Human Research Ethics Committee (EC00332) (MML HREC) in 2015. Further jurisdictional ethics approval was obtained from seven participating HRECs include the ACT Health, Northern Sydney Local Health District (NSLHD), Northern Territory Department of Health and Menzies School of Health Research, The Central Health and Disability Ethics Committee (NZ), Melbourne Health, and the Mercy Health. Governance clearance was obtained from all 26 sites involved in the trial.
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mobile applications providing guidance about decreased fetal movement review and content analysis
Women and Birth, 2019Co-Authors: Lisa M Daly, Frances M Boyle, Kristen Gibbons, Janine Roberts, Vicki FlenadyAbstract:Abstract Background Maternal Perception of decreased fetal movement has clinical significance as a predictor of pregnancies at risk of adverse outcomes, including stillbirth. Increasingly, women are using mobile applications (“apps”) to access information during the antenatal period. Little is known about how apps intended for use during pregnancy guide women to address fetal movement concerns. Objective To explore information about decreased fetal movement provided through mobile apps intended for use during pregnancy. Methods A systematic review framework was applied to the search, screening, and assessment of mobile apps. A sample of apps were downloaded in December 2016 that met inclusion criteria for accessibility, reach, relevance and quality. Data extraction was performed independently by two reviewers in January 2017. A quantitative and qualitative approach was taken to analyse data and present results. Findings All 24 apps in the sample mentioned decreased fetal movement, but few explicitly link decreased fetal movement to stillbirth or other specific adverse outcomes. There is substantial variability in guidance for fetal movement monitoring. One-quarter of apps recommend consumption of food or drink to stimulate fetal movement, two-thirds of apps recommend “kick counting”, and one-third offer a kick “counter”. Conclusion This review is the first to assess information about decreased fetal movement available in mobile apps intended for download by pregnant women. Across the sample, this review identifies a lack of evidence-based clinical advice to guide women experiencing decreased fetal movement. As an antenatal education tool used by millions of women, accurate content about fetal movement is essential.
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fetal movement assessment
Seminars in Perinatology, 2008Co-Authors: Frederik J Froen, Alexander E P Heazell, Julie Victoria Holm Tveit, Eli Saastad, Ruth C Fretts, Vicki FlenadyAbstract:Maternal Perception of fetal movements is the oldest and most commonly used method to assess fetal well-being. While almost all pregnant women adhere to it, organized screening by fetal movements has seen variable popularity among health professionals. Early results of screening were promising and fetal movement counting is the only antepartum testing method that has shown effect in reducing mortality in a randomized controlled trial comparing testing versus no testing. Although awareness of fetal movements is associated with improved perinatal outcomes, the quest to define a quantitative "alarm limit" to define decreased fetal movements has so far been unsuccessful, and the use of most such limits developed for fetal movement counting should be discouraged.
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midwives and obstetricians knowledge and management of women presenting with decreased fetal movements
Acta Obstetricia et Gynecologica Scandinavica, 2008Co-Authors: Alexander E P Heazell, Frederik J Froen, Vicki Flenady, Matthew Green, Caroline WrightAbstract:Background. Maternal Perception of decreased fetal movements (DFM) affects 5-15% of pregnancies. DFM is associated with intra-uterine fetal death (IUFD) and intra-uterine growth restriction (IUGR). It has been proposed that Maternal Perception of DFM may be used as a screening tool for IUFD or IUGR. However, this proposal is complicated by variations in definitions and management of DFM. Hypothesis. We hypothesised that uncertainties in the definition and management of women presenting with DFM leads to variation in clinical practice. Methods. A postal questionnaire was sent to midwives and consultant obstetricians in the UK. Results. The majority of respondents enquired about the presence of fetal movements after 28 weeks gestation. There was little agreement on a definition of DFM, with a Maternal Perception of decreased movements for 24 h gaining the greatest acceptance. Few practitioners used formal fetal movement counting, with the majority of respondents stating they were ineffective in the prevention of IUGR or IUFD and led to increased intervention. There was large variation in the knowledge of associations with DFM and management of women presenting with DFM. Conclusions. There were wide variations in the practice of obstetricians and midwives with regard to women presenting with DFM; many aspects of practice were not based on the available evidence. The variation in practice may result from a lack of robust evidence on which to base the provision of care. Further research is needed to provide and disseminate evidence to direct the management of women presenting with DFM.
John M D Thompson - One of the best experts on this subject based on the ideXlab platform.
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alterations in Maternally perceived fetal movement and their association with late stillbirth findings from the midland and north of england stillbirth case control study
BMJ Open, 2018Co-Authors: Alexander E P Heazell, Billie Bradford, Robin S Cronin, Lesley M E Mccowan, Jayne Budd, Edwin A Mitchell, Tomasina Stacey, Bill Martin, Devender Roberts, John M D ThompsonAbstract:Objective To report Perception of fetal movements in women who experienced a stillbirth compared with controls at a similar gestation with a live birth. Design Case–control study. Setting 41 maternity units in the UK. Participants Cases were women who had a late stillbirth ≥28 weeks gestation (n=291) and controls were women with an ongoing pregnancy at the time of the interview (n=733). Controls were frequency matched to cases by obstetric unit and gestational age. Methods Data were collected using an interviewer-administered questionnaire which included questions on Maternal Perception of fetal movement (frequency, strength, increased and decreased movements and hiccups) in the 2 weeks before the interview/stillbirth. Five fetal movement patterns were identified incorporating the changes in strength and frequency in the last 2 weeks by combining groups of similar pattern and risk. Multivariable analysis adjusted for known confounders. Primary outcome measure Association of Maternally perceived fetal movements in relation to late stillbirth. Results In multivariable analyses, women who reported increased strength of movements in the last 2 weeks had decreased risk of late stillbirth compared with those whose movements were unchanged (adjusted OR (aOR) 0.18, 95% CI 0.13 to 0.26). Women with decreased frequency (without increase in strength) of fetal movements were at increased risk (aOR 4.51, 95% CI 2.38 to 8.55). Daily Perception of fetal hiccups was protective (aOR 0.31, 95% CI 0.17 to 0.56). Conclusions Increased strength of fetal movements and fetal hiccups is associated with decreased risk of stillbirth. Alterations in frequency of fetal movements are important in identifying pregnancies at increased risk of stillbirth, with the greatest risk in women noting a reduction in fetal activity. Clinical guidance should be updated to reflect that increase in strength and frequency of fetal movements is associated with the lowest risk of stillbirth, and that decreased fetal movements are associated with stillbirth. Trial registration number NCT02025530.
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Maternal Perception of fetal activity and late stillbirth risk findings from the auckland stillbirth study
Birth-issues in Perinatal Care, 2011Co-Authors: Tomasina Stacey, Edwin A Mitchell, John M D Thompson, Alec Ekeroma, Jane Zuccollo, Lesley M E MccowanAbstract:Abstract: Background: Maternal Perception of decreased fetal movements has been associated with adverse pregnancy outcomes, including stillbirth. Little is known about other aspects of perceived fetal activity. The objective of this study was to explore the relationship between Maternal Perception of fetal activity and late stillbirth (≥ 28 wk gestation) risk. Methods: Participants were women with a singleton, late stillbirth without congenital abnormality, born between July 2006 and June 2009 in Auckland, New Zealand. Two control women with ongoing pregnancies were randomly selected at the same gestation at which the stillbirth occurred. Detailed demographic and fetal movement data were collected by way of interview in the first few weeks after the stillbirth, or at the equivalent gestation for control women. Results: A total of 155/215 (72%) women who experienced a stillbirth and 310/429 (72%) control group women consented to participate in the study. Maternal Perception of increased strength and frequency of fetal movements, fetal hiccups, and frequent vigorous fetal activity were all associated with a reduced risk of late stillbirth. In contrast, Perception of decreased strength of fetal movement was associated with a more than twofold increased risk of late stillbirth (aOR: 2.37; 95% CI: 1.29–4.35). A single episode of vigorous fetal activity was associated with an almost sevenfold increase in late stillbirth risk (aOR: 6.81; 95% CI: 3.01–15.41) compared with no unusually vigorous activity. Conclusions: Our study suggests that Maternal Perception of increasing fetal activity throughout the last 3 months of pregnancy is a sign of fetal well-being, whereas Perception of reduced fetal movements is associated with increased risk of late stillbirth. (BIRTH 38:4 December 2011)
Eli Saastad - One of the best experts on this subject based on the ideXlab platform.
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fetal movement assessment
Seminars in Perinatology, 2008Co-Authors: Frederik J Froen, Alexander E P Heazell, Julie Victoria Holm Tveit, Eli Saastad, Ruth C Fretts, Vicki FlenadyAbstract:Maternal Perception of fetal movements is the oldest and most commonly used method to assess fetal well-being. While almost all pregnant women adhere to it, organized screening by fetal movements has seen variable popularity among health professionals. Early results of screening were promising and fetal movement counting is the only antepartum testing method that has shown effect in reducing mortality in a randomized controlled trial comparing testing versus no testing. Although awareness of fetal movements is associated with improved perinatal outcomes, the quest to define a quantitative "alarm limit" to define decreased fetal movements has so far been unsuccessful, and the use of most such limits developed for fetal movement counting should be discouraged.