Reduction of late stillbirth with the introduction of fetal movement information and guidelines: A clinical quality improvement: Editorial comment

From the original article: Pregnant women with decreased fetal movements (DFM) are at increased risk of adverse outcomes such as fetal growth restriction, preterm birth, and fetal death. There is no universally accepted methodology for assessing or defining DFM and no universally accepted guidelines for the management of DFM. This prospective population-based cohort study evaluated the effectiveness of 2 specific interventions to reduce the rate of adverse pregnancy outcomes associated with decreased fetal movement in the third trimester. The first intervention was provision of information to the women on fetal activity and DFM and an invitation to monitor fetal movement. The second was preparation and distribution of DFM management guidelines for health-care professionals. All participants had singleton pregnancies of at least 28 weeks' gestation and had registered prospectively at 14 delivery units in Norway. The baseline control cohort was a group of women who had no intervention. Between 2005 and 2007, 7 months of baseline observation was followed by 17 months of intervention. The total births before and during the intervention were 19,407 and 46,143, respectively. Of these, 1215 and 3038 women with DFM were identified in the baseline and intervention cohorts, respectively. No increase was found in the number of women with DFM during the intervention. Among women with DFM, stillbirth rates were reduced by nearly 50% (adjusted odds ratio [OR], 0.51; 95% confidence interval [CI] 0.32–0.81, P = 0.004) from 4.2% (n = 50) to 2.4% (n = 73) during the intervention. Among women in the entire cohort, stillbirth rates were reduced by one-third from 3.0/1000 to 2.0/1000 (unadjusted OR, 0.67; 95% CI, 0.48–0.93, P = 0.02). No increase was found during the intervention period in rates of preterm births, fetal growth restriction, severe neonatal depression, or transfers to neonatal care among women with DFM. There was increased use of ultrasound in management and fewer additional follow up consultations and admissions for induction. These findings show that providing improved guidelines for management of DFM to health professionals together with uniform information on fetal activity to expectant women is associated with reduced stillbirth rates in this patient population