“We cannot rely on reduced foetal movement awareness as a strategy to reduce stillbirth,” said Dr Jane E. Norman of Queen’s Medical Research Institute in Edinburgh, the study’s first author.
Stillbirth prevention programs often advise pregnant women to beware of reduced foetal 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 foetal movement.
They also provided a leaflet about monitoring foetal movements to women who were about 20 weeks pregnant. The pamphlet instructed women to monitor changes in foetal 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 foetal movements.
Women who detect reduced foetal movement should still seek advice from their doctor or midwife, Norman said.
But, she added, on its own, teaching women to be aware of reduced foetal movement cannot be recommended as an effective way to reduce stillbirth.
To date, an association between stillbirth and reduced foetal 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 foetal 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 labour), and not inducing delivery in response to perception of altered movement alone would seem to be sensible first steps,” they conclude.
Source: The Lancet