Green-top Guideline No. 57 February 2011
Purpose & Scope: The purpose of this guideline is to provide advice to guide clinicians, based on the best evidence where available, regarding the management of women presenting with reduced fetal movements (RFM) during pregnancy.
Background: Fetal movements have been defined as any discrete kick, flutter, swish or roll. 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.
Jane Warland, Alexander E.P. Heazell, Tomasina Stacey, Christin Coomarasamye, Jayne Buddb, Edwin A. Mitchell, Louise M. O’Brien
OBJECTIVE: To describe and explore ’gut instinct’ that something was wrong in women who identified that they
experienced gut instinct during pregnancy.
CONCLUSION: Women who had a stillborn baby reported a “gut instinct” that something was wrong more frequently
than mothers of a live born baby. Our findings may be influenced by recall negativity bias, and a prospective
study is needed to confirm or refute our findings. The possibility that “maternal intuition” exists during pregnancy
and responds to changes in fetal or placental health merits further exploration.
Jane Warland, Pauline Glover
“Raising awareness of the existence of a health issue is often an important first step to take in reducing cases.”
Alexander E P Heazell, Christopher J Weir, Sarah J E Stock, Catherine J Calderwood, Sarah Cunningham Burley, J Frederik Froen, Michael Geary, Alyson Hunter, Fionnuala M McAuliffe, Edile Murdoch, Aryelly Rodriguez, Mary Ross-Davie, Janet Scott, Sonia Whyte, Jane E Norman
BACKGROUND: In 2013, the stillbirth rate in the UK was 4.2 per 1000 live births, ranking 24th out of 49 high-income countries, with an annual rate of reduction of only 1.4% per year. The majority of stillbirths occur in normally formed infants, with (retrospective) evidence of placental insufficiency the most common clinical finding. Maternal perception of reduced fetal movements (RFM) is associated with placental insufficiency and increased risk of subsequent stillbirth.
This study will test the hypothesis that the introduction of a package of care to increase women’s awareness of the need for prompt reporting of RFM and standardised management to identify fetal compromise with timely delivery in confirmed cases, will reduce the rate of stillbirth. Following the introduction of a similar intervention in Norway the odds of stillbirth fell by 30%, but the efficacy of this intervention (and possible adverse effects and implications for service delivery) has not been tested in a randomised trial.
Ruth C Fretts
The scope of stillbirth has been overlooked by many, few would estimate that in high income countries that, late stillbirths (pregnancies 28 weeks or later) occurs twice as often as death due to HIV/ AIDS; ten times more common than deaths due to Hepatitis B; twice a common as deaths due to congenital anomalies; twice as common as deaths due to preterm complications, and ten times more common that Sudden Infant Deaths (SIDS)
Click here for PDF on information compiled from published research data. Please note, through prenatal care, an expectant families individual history should be considered and a conversation relating to potential risk factors is suggested.
PWC for the Stillbirth Foundation
BACKGROUND: A large proportion of stillbirths are unexplained. In 2012, the number of unexplained antepartum deaths was 20.4%. 3 This lack of clarity complicates the implementation of effective interventions to reduce the rate and effects of stillbirth.
Objective: To determine if maternal country of birth is associated with the risk of antepartum stillbirth in late pregnancy.
Conclusion: Women born in South Asia have an increased risk of antepartum stillbirth in late pregnancy, compared with other women. This observation may have implications for the delivery of pregnancy care in Australia.
Click here for PDF advice compiled for government and endorsed by like minded organisations
Click here for PDF of clinical guideline produced by a multidisciplinary working group led by the Mater Research Institute, University of Queensland, Brisbane, Australia, under the auspices of the Stillbirth and Neonatal Death Alliance (SANDA) of the Perinatal Society of Australia and New Zealand (PSANZ). Endorsed by:Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG); Australian College of Midwives (ACM); Stillbirth Foundation Australia; Australian National Council for Stillbirth and Neonatal Death Support (SANDS); Red Nose; and Still Aware.
Click here for PDF of flow chart of care pathway for women presenting with DFM from 28 weeks gestation. (Gardener et al. page 9)
Jane Warland & Jillian Dorrian
BACKGROUND: There is emerging research to suggest that supine maternal sleep position in late pregnancy may adversely affect fetal wellbeing. However, these studies have all been based on maternal report of sleeping position. Before recommendations to change sleep position can be made it is important to determine the validity of these studies by investigating how accurate pregnant women are in reporting their sleep position. If avoiding the supine sleeping position reduces risk of poor pregnancy outcome, it is also important to know how well women can comply with the instruction to avoid this position and sleep on their left.
CONCLUSION: On average participant reports of sleep position were relatively accurate but there were large individual differences in reporting accuracy and in objectively-determined time on left side. Night-to-night consistency was substantial. For those who do not ordinarily sleep on that side, asking participants to sleep on their left may result in reduced sleep duration. This is an important consideration during a sleep-critical time such as late pregnancy.
New Zealand multi centre stillbirth case-control study
Lesley M. E. McCowan, John M. D. Thompson, Robin S. Cronin, Minglan Li, Tomasina Stacey, Peter R. Stone, Beverley A. Lawton, Alec J. Ekeroma, Edwin, A. Mitchell
CONCLUSION: Supine going-to-sleep position is associated with a 3.7 fold increase in overall late stillbirth
risk, independent of other common risk factors. A public health campaign encouraging
women not to go-to-sleep supine in the third trimester has potential to reduce late stillbirth
by approximately 9%.
Louise M. O’Brien & Jane Warland
Australian Institute of Health and Welfare
The AIHW reported that in 2014 there were 2,200 were stillbirths of which 51% were boys and 49% were girls/ 5.3% of which were Aboriginal and/or Torres Strait Islander.
National Centre for Immunisation Research & Surveillance (NCIRS)
Studies show, vaccines in pregnant women that there is no increased risk of adverse pregnancy outcomes (such as stillbirth, fetal distress or low birth weight) related to pertussis vaccination during pregnancy.
Australian Institute of Health & Welfare
This first Australian report of stillbirths examines the association of maternal, pregnancy and birth factors with stillbirth. The report makes use of the extensive data about pregnancy and birth that have been collected in all states and territories since 1991.