The effects of lockdown during the COVID-19 pandemic on fetal movement profiles.

PURPOSE: The current study investigated the direct impact of the COVID-19 lockdown on fetal movements, addressing a critical research gap. While previous research has predominantly examined the effects of lockdown on maternal health and postnatal outcomes, little attention has been paid to the direct consequences on fetal well-being as indicated by their movement profile. METHODS: We conducted analysis of movement profiles in 20 healthy fetuses during the COVID-19 pandemic lockdown (third national UK lockdown period between January and March 2021) and compared them with 20 healthy fetuses from pre-covid pregnancies, all at 32 weeks gestation. We controlled for maternal stress, depression, and anxiety. RESULTS: Pregnant mothers during pre-covid compared with those during the COVID-19 lockdown reported similar levels of stress (p = 0.47), depression (p = 0.15), and anxiety (p = 0.07). Their fetuses, however, differed in their movement profiles with mouth movement frequencies significantly higher during COVID-19 lockdown (COVID-19 lockdown: mean of 5.909) compared to pre-Covid pregnancies (mean of 3.308; p = 0.029). Furthermore, controlling for maternal anxiety a regression analysis indicated that frequency of fetal mouth movements (p = 0.017), upper face movements (p = 0.008), and touch movements (p = 0.031) were all significantly higher in fetuses observed during lockdown compared to fetuses before the Covid period. CONCLUSION: Fetuses show an effect of lockdown independent of maternal anxiety, stress, or depression. These findings contribute to our understanding of fetal development during extraordinary circumstances, raising questions about the potential effects of having to stay indoors during lockdowns.

Assessing fetal movements in pregnancy: A qualitative evidence synthesis of women's views, perspectives and experiences.

BACKGROUND: Raising awareness of the importance of fetal movements (FMs) and advising women on the appropriate action to take if they experience reduced FMs, is important for minimising or avoiding adverse perinatal outcomes. To gain insight and understanding of women's perspectives of assessing FMs in pregnancy, we conducted a qualitative evidence synthesis. METHODS: A qualitative evidence synthesis using thematic synthesis was conducted. Studies were eligible if they included pregnant women who were at least 20 weeks gestation and reported qualitative data from women on assessing FMs in pregnancy. MEDLINE, CINAHL, EMBASE, PsycINFO and Social Science Citation Index, from inception to July 2020, were searched. The methodological quality of included studies was assessed by at least two reviewers using an Evidence for Policy and Practice Information (EPPI)-Centre quality assessment tool. Data synthesis, using the Thomas and Harden framework, involved line by line coding of extracted data, establishing descriptive themes, and determining analytical themes. Confidence in the findings was assessed using GRADE CER-Qual. RESULTS: Nine studies, involving 2193 women, were included in the review. The methodological quality of the studies was overall generally high. The synthesis revealed three dominant themes, and seven sub-themes that reflected women's perspectives of assessing FMs in pregnancy. These were; 1) How women engage with FMs, with subthemes of informal engagement, formal engagement, and strategies to stimulate FMs; 2) ' … like a feather inside my belly' - articulating and describing FMs, with sub-themes of sensations associated with FMs and timing and frequency of FMs; and 3) FMs and help/health seeking, with sub-themes of information sources and interacting with healthcare professionals. Confidence in the findings was either high or moderate, although two findings were rated low confidence and one very low. CONCLUSION: This qualitative evidence synthesis reveals that women informally engage with FMs during pregnancy. Women commonly adopt strategies to stimulate FMs when concerned. The use of the internet was a common source of obtaining information regarding FMs. Women require better support when contacting healthcare professionals about FMs. As only three of the nine included studies were exclusively qualitative in design, further qualitative studies exploring women's perspective of assessing FMs in pregnancy are required.

Awareness of fetal movements and care package to reduce fetal mortality (AFFIRM): a stepped wedge, cluster-randomised trial.

BACKGROUND: 2·6 million pregnancies were estimated to have ended in stillbirth in 2015. The aim of the AFFIRM study was to test the hypothesis that introduction of a reduced fetal movement (RFM), care package for pregnant women and clinicians that increased women's awareness of the need for prompt reporting of RFM and that standardised management, including timely delivery, would alter the incidence of stillbirth. METHODS: This stepped wedge, cluster-randomised trial was done in the UK and Ireland. Participating maternity hospitals were grouped and randomised, using a computer-generated allocation scheme, to one of nine intervention implementation dates (at 3 month intervals). This date was concealed from clusters and the trial team until 3 months before the implementation date. Each participating hospital had three observation periods: a control period from Jan 1, 2014, until randomised date of intervention initiation; a washout period from the implementation date and for 2 months; and the intervention period from the end of the washout period until Dec 31, 2016. Treatment allocation was not concealed from participating women and caregivers. Data were derived from observational maternity data. The primary outcome was incidence of stillbirth. The primary analysis was done according to the intention-to-treat principle, with births analysed according to whether they took place during the control or intervention periods, irrespective of whether the intervention had been implemented as planned. This study is registered with www.ClinicalTrials.gov, number NCT01777022. FINDINGS: 37 hospitals were enrolled in the study. Four hospitals declined participation, and 33 hospitals were randomly assigned to an intervention implementation date. Between Jan 1, 2014, and Dec, 31, 2016, data were collected from 409 175 pregnancies (157 692 deliveries during the control period, 23 623 deliveries in the washout period, and 227 860 deliveries in the intervention period). The incidence of stillbirth was 4·40 per 1000 births during the control period and 4·06 per 1000 births in the intervention period (adjusted odds ratio [aOR] 0·90, 95% CI 0·75-1·07; p=0·23). INTERPRETATION: The RFM care package did not reduce the risk of stillbirths. The benefits of a policy that promotes awareness of RFM remains unproven. FUNDING: Chief Scientist Office, Scottish Government (CZH/4/882), Tommy's Centre for Maternal and Fetal Health, Sands.

Interventions to enhance maternal awareness of decreased fetal movement: a systematic review.

BACKGROUND: Decreased fetal movement is associated with adverse pregnancy and birth outcomes; timely reporting and appropriate management may prevent stillbirth. OBJECTIVES: Determine effects of interventions to enhance maternal awareness of decreased fetal movement. SEARCH STRATEGY: Cinahl, The Cochrane Library, EMBASE, MEDLINE, PsycINFO and SCOPUS databases; without limitation on language or publication year. SELECTION CRITERIA: Randomised or non-randomised studies evaluating interventions to enhance maternal awareness of decreased fetal movement. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data and assessed quality. MAIN RESULTS: We included 23 publications from 16 studies of fair to poor quality. We were unable to pool results due to substantial heterogeneity between studies. Three randomised controlled trials (RCTs) and five non-randomised studies (NRSs), involving 72 888 and 115 435 pregnancies, respectively, assessed effects of interventions on stillbirth and perinatal death. One large cluster RCT (n = 68 654) reported no stillbirth reduction, one RCT (n = 3111) reported significant stillbirth reduction, and one RCT (n = 1123) was small with no deaths. All NRSs favoured intervention over standard care; three studies (n = 31 131) reported significant reduction, whereas two studies (n = 84 304) reported non-significant reductions in stillbirth or perinatal deaths. Promising results from NRSs warrant further research. We found no evidence of increased maternal concern following interventions. No cost-effectiveness data were available. CONCLUSIONS: We found no clear evidence of benefit or harm; indirect evidence suggests improved pregnancy and birth outcomes. The optimal approach to support women in monitoring their pregnancies needs to be established. Meanwhile, women need to be informed about the importance of fetal movement for fetal health. TWEETABLE ABSTRACT: The benefits and risks of interventions to increase pregnant women's awareness of fetal movement are unclear.

The effect of foetal movement counting on maternal anxiety: A randomised, controlled trial.

This study assessed the effect of foetal movement counting on maternal anxiety. In a randomised, controlled trial, 208 primigravida women with a singleton pregnancy were allocated either to perform daily foetal movement counting (n100) from 28 weeks ' gestation or to follow standard Iranian antenatal care (n108). Maternal anxiety was measured by Spielberger State-Trait Anxiety Inventory. Statistical analysis was performed by SPSS (16.0). There was no significant difference in mean state and trait anxiety scores at 28 weeks ' gestation; the difference was significant at 37 weeks ' gestation in state anxiety score between the intervention and control groups (35.34 9.98 vs. 38.25 9.63, respectively, P0.001). A significant difference was found in mean trait anxiety score at 37 weeks ' gestation between the two groups (35.88 8.19 vs. 39.15 9.25, respectively, P 0.008). Women who performed foetal movement counting from 28 to 37 weeks ' gestation reported less anxiety compared with those in control group.

One size does not fit all: Perspectives from Swedish midwives on fetal movement counselling.

PROBLEM: Migration continues to play a role in determining health outcomes related to pregnancy and childbirth in Sweden. BACKGROUND: Migrant women have, compared to Swedish-born women, increased risks of adverse birth outcomes. Previous research suggests that migrant women seek care for decreased fetal movements less than Swedish-born women. Given these documented risks, understanding midwives' perspectives in this context is crucial to address maternal health inequities. AIM: To explore midwives' experiences conveying information about fetal movement to migrant women in antenatal healthcare settings. METHODS: Semi-structured, individual interviews with midwives (n=15) experienced in providing information about fetal movements to migrant women. The interviews were analysed using reflexive thematic analysis. FINDINGS: The midwives' efforts to compensate for the deficiencies within the antenatal healthcare organisation and to ensure that all women received access to information and care regarding fetal movements are described in four themes: (a) building a trusting relationship; (b) empowering women through guidance and support; (c) overcoming communication challenges; and d) navigating safety measures. DISCUSSION: Our findings suggest that the standard antenatal care programme does not support midwives to provide holistic and individualised care that aligns with midwifery care philosophy. CONCLUSION: To reduce health inequities for migrant women, this study highlights the need for more flexible guidelines within the standard antenatal care programme. These guidelines should prioritise the individual woman's needs over institutional protocols, acknowledge the midwife-woman relationship as the core of midwifery practice and support midwives to build a partnership with women through continuity of care.

Effect of the fetal movement count on maternal-fetal attachment.

AIM: This study aimed to determine the effect of fetal movement counting on maternal-fetal attachment. METHODS: This study was a randomized controlled trial, conducted with experimental and control groups, each including 55 pregnant women from six family health centers in the Malatya Province, located in the east of Turkey. The data were collected by using a Personal Information Form and the Maternal Antenatal Attachment Scale. Training for fetal movement counting was provided to the experimental group. The pre- and posttraining maternal-fetal attachment levels of the experimental group (fetal movements that were regularly counted for 4 weeks) and the control group (continual routine monitoring) were compared. RESULTS: In the pretraining pretest, no difference was found between the maternal-fetal attachment scores of the experimental and the control groups, whereas the maternal-fetal attachment score of the experimental group was found to be higher than that of the control group in the post-test that was applied 4 weeks later. CONCLUSION: This research indicated that fetal movement counting positively affected maternal-fetal attachment.

Fetal movement assessment.

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.

Can promoting awareness of fetal movements and focusing interventions reduce fetal mortality? A stepped-wedge cluster randomised trial (AFFIRM).

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. METHODS: We describe a stepped-wedge cluster trial design, in which participating hospitals in the UK and Ireland will be randomised to the timing of introduction of the care package. Outcomes (including the primary outcome of stillbirth) will be derived from detailed routinely collected maternity data, allowing us to robustly test our hypothesis. The degree of implementation of the intervention will be assessed in each site. A nested qualitative study will examine the acceptability of the intervention to women and healthcare providers and identify process issues including barriers to implementation. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Scotland A Research Ethics Committee (Ref 13/SS/0001) and from Research and Development offices in participating maternity units. The study started in February 2014 and delivery of the intervention completed in December 2016. Results of the study will be submitted for publication in peer-reviewed journals and disseminated to local investigating sites to inform education and care of women presenting with RFM. TRIAL REGISTRATION NUMBER: www.clinicaltrials.gov NCT01777022. VERSION: Protocol Version 4.2, 3 February 2017.

The effect of magnesium sulfate on the biophysical profile of normal term fetuses.

Forty term pregnant women with singleton breech gestations admitted for external cephalic version underwent biophysical profile testing before any fluid infusion or medication. After magnesium sulfate had been infused for contraction prophylaxis, the maternal serum magnesium level was measured and a second biophysical profile was performed. The mean (+/- SD) serum magnesium was 5.1 +/- 1.0 mg/dL. The biophysical profile score decreased significantly, reflecting a decrease in fetal breathing activity. In patients with therapeutic maternal serum magnesium levels, loss of any component of the biophysical profile other than respiration cannot be attributed to the elevation in magnesium concentration.

[Preterm corticosteroid therapy and fetal immobility. Case report]. / Diminution des mouvements actifs foetaux et cure de corticoïdes. A propos d'un cas.

We report a case of fetal immobility following antenatal corticosteroid therapy administered to women in thirty weeks at risk of preterm labor. The short-term side effect of corticosteroid, a decrease in fetal heart rate variation are well known. This case report presents the difficulty of therapy choice in front of fetal immobility and acute fetal distress. We chose a medical supervision. A review of the literature suggests other criteria, such as Doppler of umbilical artery, which could help therapeutical choice.

[Changing fetal position through maternal posture].

The fetal position of 249 cases in their late pregnancy was detected by ultrasound. The results showed that the position of fetal spine tended to lie on the same side as mother's posture during bedrest just before examination. Fetal posterior or transverse spinal position was prone to occur when mother was on her supine position. The fetal cephalic presentation did not correspond entirely with the fetal spinal position. Eighty of the 249 cases presenting fetal spinal posterior or transverse position were chosen at random and corrected by Sims' or hand-knee posture. The better results were obtained especially by the latter. The success rate of correction by maternal posture was affected by the engagement of fetal head and the volume of amniotic fluid. The mechanism of hand-knee posture was discussed. The result indicated that maternal posturing is a clinically valuable procedure. It may be done during pregnancy or in labor to prevent fetal malpresentation.

[Clinical experience of long-distance electronic fetal heart rate monitoring system by telephone].

OBJECTIVE: To explore the value of the long-distance electronic fetal heart rate monitoring system by telephone and explore a new way of self-monitoring at home for pregnant woman. METHOD: 204 high risk pregnant women came to our clinic were enrolled in this study. Complications included pregnancy induced hypertension (PIH), intrauterine growth retardation (IUGR), anemia, diabetes, hemolysis, nephropathy. In the study group, 97 women took the terminal part of the fetal heart rate monitoring system home and were requested to auscultate and count fetal heart rate three times a day, while another 107 cases did the self monitoring by fetal movement counting daily and served as control group. For the study group, whenever woman felt any abnormality of her baby, she could contact the long-distance electronic fetal heart rate (FHR) monitoring center in hospital by telephone immediately. The signal of fetal heart beat and fetal movement was converted and analyzed in the electronic FHR monitoring center by computer at the same time. The fetal heart rate curve was printed out, and diagnosis and management could be made. Age, gestational weeks, high risk factors, abnormal non-stress test (NST), Apgar score and birth weight of newborn were analyzed between the experimental and control group retrospectively. RESULTS: There were no obviously differences in age, gestational weeks, weight of newborn, high risk factors between the 2 groups. The incidence of abnormal NST and Apgar score of newborn were significantly higher in the study group than that in the control group, while the incidence of neonatal asphyxia was significantly lower. CONCLUSIONS: This study suggested that the long-distance electronic FHR monitoring by telephone was a reliable, sensitive and applicable method of self-monitoring for pregnant woman at home, use of this system could decrease the incidence of fetal distress, brain damage and perinatal mortality, thus improves the quality of perinatal care.

[Analysis of selected parameters of maternal and fetal status during stimulation of fetal lung maturation]. / Analiza wybranych parametrów stanu ciezarnej i plodu w trakcie stymulacji dojrzewania ukladu oddechowego.

At patients threatened with premature childbirth the influence of glicocorticoids on short and tong-term fetal heart rate variability and the occurrence of respiratory arrhythmia was evaluated. It has been ascertained statistical significant lowering of the incidence of fetal respiratory arrhythmia and short-term variability. Described changes had a temporary character and surrendered of normalization in the course 72 of hours after last use of glicocorticoids. The influence of glicocorticoids on select biochemical and biophysical parameters of state pregnant women was also studied. One specified occurrence of incidental symptoms in road drove of therapy. Pregnant women in road of treatment glicocorticoids have also observed a temporary weakness of feeling of fetal movements.

The antenatal CTG.

The cardiotocograph (CTG) is widely used in the antenatal period, often for women who present with reduced fetal movements.

Continuous objective recording of fetal heart rate and fetal movements could reliably identify fetal compromise, which could reduce stillbirth rates by facilitating timely management.

Stillbirth currently affects approximately 1 in every 200 pregnancies in the United Kingdom. Fetuses may exhibit signs of compromise as part of a stress response before stillbirth, including reduced fetal movements (RFM) and fetal heart rate (FHR) alterations. At present, and despite widespread use, current fetal monitoring is not associated with a reduction in perinatal mortality rate (PMR) as signs of fetal compromise are not adequately detected. This may be attributed to inaccuracies resulting from manual interpretation of results or subjective assessment of fetal activity. In addition, signs of compromise often occur only hours or days before fetal death, so may be missed by current monitoring methods, which are performed intermittently. A significant consideration is that correct identification of these signs and consequent intervention can result in the delivery of a healthy baby, thus preventing stillbirth. A hypothesis is presented, proposing prompt detection of fetal compromise with the use of 24-hour continuous objective fetal monitoring. With focus placed on obtaining long-term FHR and fetal movement data, prior interest has been found in developing devices for this purpose. However, introduction into clinical practice has not been achieved. Investigation of the hypothesis will begin with the design of a device to record the mentioned parameters, followed by an appropriate validation process. Should development and testing be successful, an eventual comparison in PMR with the use of continuous fetal monitoring vs current monitoring would address the hypothesis. It is suggested that a timely yet reliable indication of fetal wellbeing obtained via long-term monitoring would allow prompt and appropriate obstetric intervention and consequently reduce PMR.