Fetal movement counting is associated with the reduction of delayed maternal reaction after perceiving decreased fetal movements: a prospective study.

Maternal perception of decreased fetal movement is associated with adverse perinatal outcomes. Although there have been several studies on interventions related to the fetal movements count, most focused on adverse perinatal outcomes, and little is known about the impact of the fetal movement count on maternal behavior after the perception of decreased fetal movement. We investigated the impact of the daily fetal movement count on maternal behavior after the perception of decreased fetal movement and on the stillbirth rate in this prospective population-based study. Pregnant women in Shiga prefecture of Japan were asked to count the time of 10 fetal movements from 34 weeks of gestation. We analyzed 101 stillbirths after the intervention compared to 121 stillbirths before the intervention. In multivariable analysis, maternal delayed visit to a health care provider after the perception of decreased fetal movement significantly reduced after the intervention (aOR 0.31, 95% CI 0.11-0.83). Our regional stillbirth rates in the pre-intervention and post-intervention periods were 3.06 and 2.70 per 1000 births, respectively. Informing pregnant women about the fetal movement count was associated with a reduction in delayed maternal reaction after the perception of decreased fetal movement, which might reduce stillbirths.

Women's experience of wearing a portable fetal-electrocardiogram device to monitor small-for-gestational age fetus in their home environment.

OBJECTIVE: To determine the acceptability, to women, of wearing a portable fetal electrocardiogram recording device at different stages of pregnancy and to gain insight into their experience of its use for long-periods of monitoring of small-for-gestational fetuses in the home environment. METHODS: A qualitative study using both a questionnaire and focus group involving women with singleton pregnancy >24 weeks gestation, no evidence of fetal malformation and an estimated fetal weight below 10th gestational centile on ultrasound scan. Fetal heart rate recordings were collected for up to 20 h. RESULTS: In total, 59 questionnaires were completed; 35 after wearing the monitor for the first time and an additional 24 from the women who wore the device for a second time. Six women participated in the focus group; the principal theme identified related to the practicality of the fetal electrocardiogram device. Other themes identified were the discomfort that resulted from wearing the monitor and the reassurance provided in knowing that the baby's heart rate was being monitored. CONCLUSION: Long-term ambulatory fetal electrocardiogram monitoring is an acceptable method of monitoring small-for-gestational fetuses. Overall, women concluded that benefits of wearing the device outweighed any discomfort it caused.

Healthcare providers' perspectives on labor monitoring in Nigeria and Uganda: A qualitative study on challenges and opportunities.

OBJECTIVE: To explore current practices, challenges, and opportunities in relation to monitoring labor progression, from the perspectives of healthcare professionals in low-resource settings. METHODS: Thematic analysis of qualitative data (in-depth interviews [IDIs] and focus group discussions [FDGs]) obtained from a purposive sample of healthcare providers and managers in selected health facilities in Nigeria and Uganda. RESULTS: A total of 70 IDIs and 16 FGDs with doctors, midwives, and administrators are included in this analysis. Labor monitoring encompasses a broad scope of care jointly provided by doctors and midwives. A range of contextual limitations was identified as barriers to monitoring labor progression, including staff shortages, lack of team cooperation, delays in responding to abnormal labor observations, suboptimal provider-patient dynamics, and limitations in partograph use. Perceived opportunities to improve current practices included streamlining clinical team cooperation, facilitating provider-client communication, encouraging women's uptake of offered care, bridging the gaps in the continuum of monitoring tasks between cadres, and improving skills in assessment of labor progress, and accuracy in its documentation. CONCLUSION: Healthcare providers face many challenges to effective monitoring of labor progress in low-resource settings. This analysis presents potential opportunities to improve labor monitoring practices and tools in these contexts.

A pilot exploratory investigation on pregnant women's views regarding STan fetal monitoring technology.

BACKGROUND: Women's views are critical for informing the planning and delivery of maternity care services. ST segment analysis (STan) is a promising method to more accurately detect when unborn babies are at risk of brain damage or death during labour that is being trialled for the first time in Australia. This is the first study to examine women's views about STan monitoring in this context. METHODS: Semi-structured interviews were conducted with pregnant women recruited across a range of clinical locations at the study hospital. The interviews included hypothetical scenarios to assess women's prospective views about STan monitoring (as an adjunct to cardiotocography, (CTG)) compared to the existing fetal monitoring method of CTG alone. This article describes findings from an inductive and descriptive thematic analysis. RESULTS: Most women preferred the existing fetal monitoring method compared to STan monitoring; women's decision-making was multifaceted. Analysis yielded four themes relating to women's views towards fetal monitoring in labour: a) risk and labour b) mobility in labour c) autonomy and choice in labour d) trust in maternity care providers. CONCLUSIONS: Findings suggest that women's views towards CTG and STan monitoring are multifaceted, and appear to be influenced by individual labour preferences and the information being received and understood. This underlies the importance of clear communication between maternity care providers and women about technology use in intrapartum care. This research is now being used to inform the implementation of the first properly powered Australian randomised trial comparing STan and CTG monitoring.

Women's attitudes, experiences and compliance concerning the use of Mindfetalness- a method for systematic observation of fetal movements in late pregnancy.

BACKGROUND: Maternal perception of decreased fetal movements and low awareness of fetal movements are associated with a negative birth outcome. Mindfetalness is a method developed for women to facilitate systematic observations of the intensity, character and frequency of fetal movements in late pregnancy. We sought to explore women's attitudes, experiences and compliance in using Mindfetalness. METHODS: We enrolled 104 pregnant women treated at three maternity clinics in Stockholm, Sweden, from February to July of 2016. We educated 104 women in gestational week 28-32 by providing information about fetal movements and how to practice Mindfetalness. Each was instructed to perform the assessment daily for 15 min. At each subsequent follow-up, the midwife collected information regarding their perceptions of Mindfetalness, and their compliance. Content analyses, descriptive and analytic statistics were used in the analysis of data. RESULTS: Of the women, 93 (89%) were positive towards Mindfetalness and compliance was high 78 (75%). Subjective responses could be binned into one of five categories: Decreased worry, relaxing, creating a relationship, more knowledge about the unborn baby and awareness of the unborn baby. Eleven (11%) women had negative perceptions of Mindfetalness, citing time, and the lack of need for a method to observe fetal movements as the most common reasons. CONCLUSION: Women in late pregnancy are generally positive about Mindfetalness and their compliance with daily use is high. The technique helped them to be more aware of, and create a relationship with, their unborn baby. Mindfetalness can be a useful tool in antenatal care. However, further study is necessary in order to determine whether the technique is able to reduce the incidence of negative birth outcome.

Professionals' views of fetal-monitoring support the development of devices to provide objective longer-term assessment of fetal wellbeing.

OBJECTIVE: Continuous longer-term fetal monitoring has been proposed to address limitations of current technologies in the detection of fetal compromise. We aimed to assess professionals' views regarding current fetal-monitoring techniques and proposed longer-term continuous fetal monitoring. METHODS: A questionnaire was designed and validated to assess obstetricians' and midwives' use of current fetal-monitoring techniques and their views towards continuous monitoring. 125 of 173 received responses (72% obstetricians, 28% midwives) were analysed. RESULTS: Professionals had the strongest views about supporting evidence for the most commonly employed fetal-monitoring techniques (maternal awareness of fetal movements, ultrasound assessment of fetal growth and umbilical artery Doppler). 45.1% of professionals agreed that a continuous monitoring device would be beneficial (versus 28.7% who disagreed); this perceived benefit was not influenced by professionals' views regarding current techniques or professional background. Professionals have limited experience of continuous fetal monitoring, but most respondents believed that it would increase maternal anxiety (64.3%) and would have concerns with its use in clinical practice (81.7%). CONCLUSION: Continuous fetal monitoring would be acceptable to the majority of professionals. However, development of these technologies must be accompanied by extended examination of professionals' and women's views to determine barriers to its introduction.

The psychosocial impact of inpatient management of monoamniotic twin gestations.

OBJECTIVE: Monoamniotic twins require unique considerations in clinical management that challenge both clinicians and patients. The aim of this study was to assess the psychosocial impact of inpatient antepartum versus outpatient management for these patients. METHODS: Women with a history of a monoamniotic twin pregnancy between 2002 and 2012 were identified through a social media group and invited to participate in an original survey regarding their clinical management and psychological well-being during gestation. Results between patients managed with inpatient versus outpatient protocols were compared using the Fisher exact test. RESULTS: Participants (n = 197) were multinational. Planned inpatient management after 23 weeks gestation was reported in 76.2% of respondents. Participants in both groups endorsed persistent feelings of hopelessness or despair related to their pregnancies (42.4% of inpatients versus 24.1% of outpatients, p = 0.089). Relationship strain between participants and their partners was similar in both the groups. Participants in the outpatient group were more likely to report feelings of guilt related to their infrequent monitoring (p = 0.01). Patient satisfaction with care was higher in the inpatient group. CONCLUSIONS: Inpatient management did not significantly increase measures of psychosocial stress as compared to outpatient management. Participants in the outpatient group reported feelings of guilt about their infrequent monitoring. Our findings provide increased understanding of the patient experience in these rare and challenging clinical circumstances.

Women's experiences of outpatient induction of labour with remote continuous monitoring.

OBJECTIVE: to gain insight into women's experiences and preferences for induction in the home as part of a trial investigating the feasibility and acceptability of outpatient induction of labour with remote monitoring. DESIGN: a qualitative study using semi-structured individual interviews. Interview transcripts were subjected to thematic analysis to identify the dominant themes regarding women's experiences of outpatient induction. SETTING: a large maternity hospital in the North West of England. PARTICIPANTS: fifteen women who participated in the main trial of outpatient induction of labour with remote continuous monitoring. FINDINGS: three main themes were identified; the need for women to 'labour within their comfort zone'; their desire to achieve 'the next best thing to a normal labour' and the importance of a 'virtual presence' to offer remote reassurance. CONCLUSIONS: women's preference for the outpatient setting of induction of labour is dominated by their need to labour within their comfort zone. Outpatient induction offered women the familiarity and freedom of the home environment, and the resulting physical and emotional comforts helped women cope better with their labour and improved their birth experiences. While remote monitoring offered some reassurance, women still depended on effective communication from hospital staff to provide the virtual presence of a health professional in the home. IMPLICATIONS: the combination of slow-release prostaglandin and a remote monitoring device may provide low risk women with an improved induction and labour experience. While ongoing studies continue to explore further the safety of interventions at home, this study has importantly considered women's views and confirmed that induction at home is not only acceptable to women but also that the outpatient experience is preferable to long inpatient inductions.

A review and psychometric evaluation of pregnancy-specific stress measures.

Considerable evidence has accumulated on the association between pregnancy-specific stress and adverse birth outcomes with an increasing number of measures of pregnancy-specific stress being developed internationally. However, the introduction of these measures has not always been theoretically or psychometrically grounded, resulting in questions about the quality and direction of such research. This review summarizes evidence on the reliability and validity of pregnancy-specific stress measures identified between 1980 and October 2010. Fifteen pregnancy-specific stress measures were identified. Cronbach's alpha coefficient ranged from 0.51-0.96 and predictive validity data on preterm birth were reported for five measures. Convergent validity data suggest that pregnancy-specific stress is related to, but distinct from, global stress. Findings from this review consolidate current knowledge on pregnancy-specific stress as a consistent predictor of premature birth. This review also advances awareness of the range of measures of pregnancy-specific stress and documents their strengths and limitations based on published reliability and validity data. Careful consideration needs to be given as to which measures to use in future research to maximize the development of stress theory in pregnancy and appropriate interventions for women who experience stress in pregnancy. An international, strategic collaboration is recommended to advance knowledge in this area of study.

Maternal satisfaction and acceptability of foetal electrocardiographic (STAN®) monitoring system.

OBJECTIVE: To assess the acceptability of the foetal electrocardiographic (STAN®) monitoring system by patients at a London Hospital, before its introduction into routine clinical care. METHOD: This was a prospective questionnaire-based study of patients who were monitored in labour by foetal electrocardiographic (STAN®) monitoring system. RESULTS: Ninety-three percent (CI 85, 98) of the patients felt that the midwife(s) responsible for their intrapartum care took time to explain why their babies were being monitored continuously in the first instance. Ninety-nine percent (CI 93, 99.9) of patients felt that the obstetricians explained why they were being monitored continuously in labour. After delivering and having been monitored with STAN® 95% (CI 87, 99) of women felt that it was an acceptable way of monitoring their babies in labour. CONCLUSION: In resource-limited organisation, such as the NHS, holistic approach to intrapartum care may sometimes feel difficult to achieve. However, with emphasis on women centred care and information sharing women are able to understand and comment on intrapartum monitoring systems.

[Disputes and history of fetal heart monitoring]. / Controversias e historia del monitoreo cardiaco fetal.

The concept of fetal heart monitoring to determine the fetal wellbeing state has been employed for almost 300 years, but in the last 50 years it has observed drastic changes due to the incorporation of the electronic devices that has started controversy since the moment of its description and point of start. The purpose of this article is to mention the key points and controversial moments in the history of the cardiotocography

Validation of a trust in medical technology instrument.

A patient's trusting attitude towards technology used in their medical care may be a predictor of acceptance or rejection of the technology and, by extension, the physician. The aim of this study was to rigorously determine the validity of an instrument for measuring patients' trust in medical technology. Instrument validity was established based on a framework, which included test and data evidence for validity assessment. The framework for validity assessment evaluates the instrument on content, substantive, structural, generalizability, external and consequential aspects of validity. The results of the current study show that the instrument is reliable and valid for assessing a patient's trust in obstetric medical technology.

Prenatal origins of temperamental reactivity in early infancy.

BACKGROUND: Temperament theory has long considered individual differences in reactivity and regulation to be present at birth. Recent evidence suggests that such differences may be present prenatally and moderated by maternal emotionality. AIMS: To determine whether induced maternal emotional activation generates a fetal response and whether observed fetal responsivity is associated with early infant temperament. STUDY DESIGN: Women viewed an emotionally evocative labor and delivery documentary at 32 weeks gestation while physiological indices were evaluated and their infant's temperament was assessed at 6 weeks postnatal age. SUBJECTS: Participants were 137 pregnant women and their infants. OUTCOME MEASURES: Maternal physiological (heart rate and skin conductance) and fetal neurobehavioral (heart rate and motor activity) data were collected during gestation in response to the stimulus. Infant temperament (irritability and consolability) data were based on observational methods after birth. RESULTS: Fetuses reacted to maternal viewing of the video with decreased heart rate variability, fewer motor bouts, and decreased motor activity. There was correspondence between the nature of individual maternal physiological responses to the full video, as well as phasic responses to a graphic birth scene, and fetal responsivity. Fetuses that reacted more intensively to maternal stimulation were significantly more likely to become infants that demonstrated greater irritability during a developmental examination at 6 weeks of age. DISCUSSION: These results support the presumption that early postnatal temperamental characteristics emerge during the prenatal period.

The effects of different maternal positions on non-stress test: an experimental study.

AIMS AND OBJECTIVES: To determine the effects of different maternal positions on non-stress test results and the preferences of mothers for involving positions. BACKGROUND: The non-stress test (NST) has become a common tool in diagnosing fetal risks. The major problem encountered in the application of the non-stress test has been obtaining erroneous non-reactive non-stress test results when, indeed, the fetus is healthy and oxygenation is sufficient. STUDY DESIGN: Experiment design with randomly assigned four positions: supine, left lateral, semi-fowler and sitting up. The sample included 408 women in a university hospital in Turkey. Women were randomly assigned to four groups in equal numbers of 102. Data collection and analysis. Data were collected through two instruments: Demographic and Pregnancy History Form and NST tracing. Main outcome measures were percentage of reactive NST and number of minutes for reactivity in each position. RESULTS: There were significant (P < 0.05) differences among four groups. Supine position showed the least fetal reactivity. In terms of time to reactivity, there were no statistically significant differences. Qualitative data showed that pregnant women were least comfortable in supine position reporting back pain and shortening of breath. CONCLUSION: Supine position yields the lowest non-reactivity in tandem with physical discomfort such as back pain and difficulty in breathing. RELEVANCE TO CLINICAL PRACTICE: Sitting up, semi-fowler and left lateral positions are recommended to be used during the non-stress test. In addition, the preferences of the pregnant women should be determined before the test to minimize discomfort which, when it occurs, may signal physiological alterations experienced during the test.

Should women be given a choice about fetal assessment in labor?

Continuous electronic fetal monitoring (EFM) in labor is one of the most commonly used interventions during intrapartum care. However, randomized controlled trials, observational studies, and meta-analyses about the use of continuous EFM on low-risk intrapartum patients have found no significant differences in infant outcomes between infants whose mothers had EFM or intermittent auscultation (IA) of the fetal heart rate. In addition, research shows a higher incidence of cesarean birth when EFM is used. Although evidence-based practice is supposed to be our goal, the evidence about the lack of efficacy of EFM has not been used in practice. In fact, EFM has become the standard of practice in this country. Considering these facts, should EFM continue to be the standard of practice for low-risk laboring women? Is informed consent indicated, giving women the choice between EFM and IA? Should IA be offered to all low-risk laboring women? Ethical decision-making models are used to examine those questions and to help nurses better delineate their advocacy role.

Labor and delivery nurses' attitudes toward intermittent fetal monitoring.

Fetal monitoring is a routine procedure overseen by labor and delivery nurses and upon which they exert considerable influence. There is a discrepancy, however, between the type of fetal monitoring routinely used and the evidence provided by current research and professional organization recommendations. This study provides the first look at labor and delivery nurses' attitudes toward fetal monitoring in more than 20 years. A descriptive, correlational study was conducted at five southeastern Michigan hospitals to evaluate attitudes toward intermittent fetal monitoring and the effect of selected demographic variables on their attitudes. Of the labor and delivery nurses who participated (N = 145), 72.4% agreed that intermittent fetal monitoring should be the standard of care. Although 87% of the respondents stated that they were willing to provide intermittent monitoring, 53.9% indicated that nurse/patient ratios were a problem in providing this service. Nurses' attitudes were significantly influenced by education level (P = .004), and 48% were unsure about current research findings related to intermittent auscultation. Nurses have a positive attitude toward intermittent monitoring, although safe nurse/patient ratios and clear policies need to be addressed. Lack of knowledge regarding the current evidence and other barriers may contribute to intermittent auscultation not being used routinely, despite the fact that its use for women of low obstetrical risk is supported by current research and professional organizations.