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1.
Minerva Obstet Gynecol ; 74(5): 401-409, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36239529

RESUMO

BACKGROUND: Fetal movements are one of the simple methods that show the baby's well-being. Conditions associated with decreased fetal movements have not been determined, so it is important to analyze their different aspects. This study aimed to evaluate the relationship between reduced fetal movement and obstetric-neonatal outcomes, and placental pathologies. METHODS: In this prospective controlled study, laboratory results (blood glucose, hemoglobin, thyroid-stimulating hormone [TSH]), a non-stress test (NST), biophysical profile results, obstetric and neonatal outcomes, and placental pathological results of 74 pregnant women at 35 or more gestational weeks (to exclude the effect of prematurity on obstetric and neonatal outcomes) attending the obstetrics clinic between December 26, 2017 and January 30, 2019 with complaints of reduced fetal movement, were compared with 74 healthy pregnant women. Since prematurity and post-maturity may adversely affect obstetric-neonatal and placental pathology results, term pregnancies between 370/7-406/7 weeks were evaluated separately. RESULTS: In the group with reduced fetal movement, the biophysical profile was lower than the controls (P=0.013). Among placental pathologies, chorangiosis and hypercoiled cord were significantly higher in the group with reduced fetal movement than controls (P<0.05). Small for gestational age (SGA) and fetal growth restriction (FGR) in this group had these pathologies. Results of women at 370/7-406/7 weeks were similar except for the additional finding of chorioamnionitis. CONCLUSIONS: Reduced fetal movement may be associated with the low biophysical profile. In cases where fetal movement decreases, placental chorangiosis and hypercoiled cord seem to be associated with fetal growth restriction.


Assuntos
Retardo do Crescimento Fetal , Placenta , Recém-Nascido , Feminino , Gravidez , Humanos , Retardo do Crescimento Fetal/patologia , Placenta/patologia , Movimento Fetal , Estudos Prospectivos , Recém-Nascido Pequeno para a Idade Gestacional
2.
Indian J Public Health ; 66(3): 341-343, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36149118

RESUMO

Providing comfort to an antenatal mother is one of the critical components of the nonstress test (NST). An experimental study was conducted on 450 antenatal mothers beyond 34 weeks, who were randomly allocated into three groups - supine, left lateral, and semi-fowler's position, to explore the association of selected maternal positions on NST results and to find the impact of these positions on the comfort level of antenatal mothers. The fetal parameters were assessed by observing and recording biophysiological measurements from the NST and the maternal comfort of different positions by the Verbal Numerical Rating Scale. The data analyzed reveal a significant association between maternal positions and fetal parameters at P < 0.05 level. Antenatal women who were in semi-fowler's position exhibited more comfort and fetal NST reactivity as noted by significant variation in the baseline fetal heart rate, beat-to-beat variability, acceleration, deceleration, and fetal movements.


Assuntos
Monitorização Fetal , Mães , Feminino , Monitorização Fetal/métodos , Movimento Fetal , Humanos , Índia , Gravidez , Cuidado Pré-Natal
3.
Annu Int Conf IEEE Eng Med Biol Soc ; 2022: 2017-2020, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-36086419

RESUMO

This study addresses the cancellation of fetal movement in abdominal electrocardiogram (AECG) recordings through deep neural networks. For this purpose, a generative signal-to-signal translation model consisting of two coupled generators is employed to discover the relations between fetal movement-contaminated and clean AECG recordings. The model is trained on the fetal ECG synthetic database (FECGSYNDB) which provides AECG recordings from 10 pregnancies along with their ground-truth maternal and fetal ECG signals. The signals are initially segmented into 4-second segments and then fed into the network for denoising. It is demonstrated that the signal-to-signal translation method can reconstruct clean AECG signals with average mean-absolute-error (MAE), root-mean-square deviation (RMSD), and Pearson correlation coefficient (PCC) of 0.099, 0.124, and 99.12% respectively, between clean and denoised AECG signals. Furthermore, the robustness of the method to low signal-to-noise ratio (SNR) input values is shown by an RMSD range of (0.047, 0.352) for SNR values within the range of (-3, 3) dB. Clinical Relevance- The proposed framework allows for the denoising of abdominal ECG signals for non-invasive fetal heart rate monitoring. The approach is accurate due to the use of advanced neural network techniques.


Assuntos
Movimento Fetal , Processamento de Sinais Assistido por Computador , Abdome , Algoritmos , Eletrocardiografia/métodos , Feminino , Humanos , Gravidez
4.
J Matern Fetal Neonatal Med ; 35(23): 4543-4551, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36062520

RESUMO

BACKGROUND: Pregnancies with reduced fetal movements (RFM) are at risk for poor neonatal outcomes and stillbirth. AIM: To investigate whether Doppler measurements or angiogenic factors are good predictors of adverse neonatal outcomes in pregnancies with RFM. METHODS: This is a prospective pilot cohort study of 3243 women seeking care for RFM. Standard care was carried out in all cases. An extra Doppler examination was performed in 128 women to assess the flow in the middle cerebral artery, the umbilical artery, and the uterine artery. In 62/128 pregnancies, a maternal blood sample was obtained for angiogenic and antiangiogenic factors. The composite neonatal outcome of the study was one or more of the following factors: Apgar score <7 at 5', arterial aPh in the umbilical cord ≤7.1, transfer to Neonatal Intensive Care (NICU), stillbirth, and small for gestational age (SGA). RESULTS: In 14.1% (18/128) of the Doppler group and 11.7% (365/3115) of the standard care group, there was an adverse neonatal outcome (p = .51). A higher intervention rate was found in the Doppler group (28% vs. 5.4%, p < .01). The predictive model of adverse neonatal outcomes in women with RFM with angiogenic factors was 0.73 (95% CI 0.54-0.92). The area under the curve improved to 0.89 (CI 95% 0.81-0.97) when parity was added to the model. CONCLUSION: Angiogenic factors may have a place in the prediction of the neonatal outcome of RFM pregnancies. The prediction model's capacity was driven by parity. The obstetrical intervention rate increased with additional Doppler examinations.


Assuntos
Movimento Fetal , Natimorto , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Projetos Piloto , Gravidez , Estudos Prospectivos , Natimorto/epidemiologia , Ultrassonografia Pré-Natal
5.
Psychol Sci ; 33(10): 1651-1663, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36130610

RESUMO

The diet of pregnant women exposes fetuses to a variety of flavors consisting of compound sensations involving smell, taste, and chemesthesis. The effects of such prenatal flavor exposure on chemosensory development have so far been measured only postnatally in human infants. Here, we report the first direct evidence of human fetal responsiveness to flavors transferred via maternal consumption of a single-dose capsule by measuring frame-by-frame fetal facial movements. Pregnant women and their fetuses based in the northeast of England were involved in this study from 32 to 36 weeks' gestation. Fetuses exposed to carrot flavor (n = 35) showed "lip-corner puller" and "laughter-face gestalt" more frequently, whereas fetuses exposed to kale flavor (n = 34) showed more "upper-lip raiser," "lower-lip depressor," "lip stretch," "lip presser," and "cry-face gestalt" in comparison with the carrot group and a control group not exposed to any flavors (n = 30). The complexity of facial gestalts increased from 32 to 36 weeks in the kale condition, but not in the carrot condition. Findings of this study have important implications for understanding the earliest evidence for fetal abilities to sense and discriminate different flavors.


Assuntos
Feto , Paladar , Dieta , Feminino , Movimento Fetal , Humanos , Lactente , Gravidez , Olfato
6.
J Nepal Health Res Counc ; 20(1): 21-25, 2022 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-35945848

RESUMO

BACKGROUND: Establishing the predictive utility of Non stress test could be helpful to improve perinatal outcome especially in countries like Nepal, with heavy workload and limited resources. The aim of the study was to assess association between Non stress test abnormalities and fetal outcome in terms of Apgar score and newborn intensive care unit admission rate for patient with decreased fetal movement. METHODS: The study included total 54 women with decreased fetal movement at term without any pregnancy complication not in labor admitted to paropakar maternity and women's hospital, Thapathali, Kathmandu from June 2020 to December 2020. Non stress test was done for 20 to 40 minutes and the readings were categorized in to three groups. The results were compared to see the relationship between normal, suspicious and abnormal Non stress test result in terms of mode of delivery, Apgar score, neonatal resuscitation and need for neonatal intensive care unit newborn intensive care unit admission. RESULTS: Total 54 cases remained under inclusion criteria were included in this study. Mode of delivery on the basis of Non stress test result shows that 31.48% with abnormal Non stress test had a Lower segment Caesarian section, 1.8% had instrumental vaginal delivery and 14.8% had spontaneous vaginal delivery. While in reassuring Non stress test group 20.4% had spontaneous vaginal, 0% had Lower segment Caesarian section and 1.85% had instrumental vaginal delivery. There is statistically significant relationship between Non stress test result and Apgar score. In reactive Non stress test result only5.4% required neonatal resuscitation. However, in persistently non-reassuring or abnormal Non stress test result, 62.1% require neonatal resuscitation. Similarly, in reactive Non stress test result none of the neonate required newborn intensive care unit admission. However, in persistently non-reassuring or abnormal Non stress test result 46.1% neonates require newborn intensive care unit admission. There were 9 neonatal mortalities from abnormal Non stress test result. CONCLUSIONS: We concluded that the Non stress test is a good predictor of maternal and fetal outcome detecting fetal hypoxia already present or likely to develop in patient presenting with reduced fetal movement in term pregnancies without complication.


Assuntos
Movimento Fetal , Trabalho de Parto , Parto Obstétrico , Feminino , Humanos , Recém-Nascido , Nepal , Gravidez , Resultado da Gravidez , Ressuscitação
7.
J Perinat Med ; 50(9): 1174-1179, 2022 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-35779269

RESUMO

OBJECTIVES: The purpose of this study was to determine the onset of fetal movements' perception and to identify parameters that affect this timing. METHODS: This was a prospective cohort study including singleton pregnancies that attended routine prenatal care, in a tertiary care center, in northern Greece, between January 2020 and July 2021. We collected data on medical and obstetric history, and invited women to record the time that they perceived the fetal movements for the first time, that being the primary outcome of the study. Furthermore, we studied the associations between this timing and several obstetric and sociodemographic parameters. RESULTS: In total, 2,009 women participated in the study. The mean gestational age at first perception of fetal movements was 19 weeks (±1.5). This ranged from as early as 14+0-14+6 weeks (0.1%) to 24+0-24+6 weeks (0.1%). The majority of women (73.3%) reported initial perception of fetal movements between 18+0 and 20+6 weeks. Following multivariate logistic regression analysis, we found that nulliparity (OR: 2.607; 95% CI: 1.876-3.622; p<0.001), anterior placental position (OR: 1.918; 95% CI: 1.575-2.336; p<0.001), increasing body mass index (OR: 1.063; 95% CI: 1.040-1.088; p=0.001) and advancing maternal age (OR: 1.062; 95% CI: 1.040-1.084; p<0.001) were associated with a delayed perception of fetal movements. Multiparous women reported the onset of fetal movements almost one week earlier on average (18.6±1.4 weeks) compared to nulliparous (19.4±1.4 weeks; MD: 0.843; 95% CI: 0.718-0.968; p<0.001). CONCLUSIONS: The onset of maternal perception of fetal movements is around 19 weeks and this timing may be delayed by higher maternal age, higher body mass index, nulliparity and anterior placental position.


Assuntos
Movimento Fetal , Placenta , Feminino , Gravidez , Humanos , Lactente , Estudos Prospectivos , Paridade , Percepção
8.
Sci Rep ; 12(1): 8236, 2022 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-35581284

RESUMO

Eye movement density (EMD) is an evaluation index of rapid eye movements observed during sleep. This study aimed to investigate the association of fetal EMD with sleeping and developmental problems in infancy. We observed 60 normal singleton pregnancies (gestational age 28-37 weeks) using ultrasonography for 1 h. Fetal eye movements were counted, and EMD was calculated. Participants answered questionnaires regarding their child's sleep and development 1.5 years after their delivery. The outcomes of an infant's sleep were night awakening (yes or no), bedtime (before or after 22:00), and nighttime sleep duration (< 9 or ≥ 9 h). An infant's development was evaluated using the Child Behavior Checklist (CBCL) T-score. We found that decreased fetal EMD was associated with increased night awakening at the age of 1.5 years (odds ratio 0.84, 95% confidence interval 0.69-1.00 per unit decrease in EMD). However, fetal EMD was not associated with bedtime or nighttime sleep duration. In addition, fetal EMD was independently associated with the total problems T-score of the CBCL at the age of 1.5 years in the multivariate model (p = 0.047). In conclusion, fetal EMD may be associated with sleep and developmental problems in infants.


Assuntos
Movimentos Oculares , Sono , Criança , Feminino , Movimento Fetal , Humanos , Lactente , Gravidez , Sono REM , Inquéritos e Questionários
10.
Tohoku J Exp Med ; 257(1): 17-22, 2022 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-35387908

RESUMO

Fetal growth restriction (FGR) is defined as fetuses who have failed to achieve a normal weight for gestational age. FGR is associated with adverse perinatal outcomes, including stillbirth. Pregnant women often perceive decreased fetal movements before intrauterine fetal death. Previous reports on the association between fetal movements and FGR have mainly targeted livebirths, with few focusing on stillbirths. Studying stillbirths, not livebirths, may help improve perinatal adverse outcomes. This study evaluated the association between FGR leading to stillbirth and maternal perception of decreased fetal movement. This was a population-based study reviewing all stillbirths in Shiga Prefecture, Japan for 10 years. We analyzed 219 stillbirth cases, those with versus without FGR. We then compared maternal visits to healthcare providers due to perception of decreased fetal movement between these two groups. There were 82 stillbirths with FGR, and the remaining 137 stillbirth were without FGR. Women with FGR, compared with those without, were significantly less often to visit the outpatient department due to decreased fetal movement (30%; 25/82 vs. 46%; 63/137: P = 0.034). Pregnant women have more difficulty perceiving decreased fetal movements in cases with severe FGR than in those without FGR. Healthcare providers, including midwives, may need to closely monitor FGR pregnancy in addition to instructing pregnant women to be aware of decreased fetal movement.


Assuntos
Retardo do Crescimento Fetal , Natimorto , Feminino , Retardo do Crescimento Fetal/epidemiologia , Movimento Fetal , Idade Gestacional , Humanos , Japão/epidemiologia , Percepção , Gravidez , Natimorto/epidemiologia
11.
Physiol Rep ; 10(6): e15224, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35307959

RESUMO

Fetal heart rate variability (FHRV) reflects autonomic cardiac regulation. The autonomic nervous system constantly adjusts the heart rate to maintain homeostasis. By providing insight into the fetal autonomic state, FHRV has the potential to become an investigational and clinical instrument. However, the method needs standardization and the influence of fetal movements, including fetal respiratory movements, is not well explored. Therefore, in a highly standardized setting, the aim was to evaluate the association between fetal movements and fetal heart rate variability (FHRV) including their impact on reliability. Fetal heart rate was obtained by noninvasive fetal electrocardiography (NI-FECG) and fetal movements by simultaneous ultrasound scanning in 30 healthy singleton pregnant women on two occasions with a maximum interval of 7 days. The standard deviation of normal-to-normal RR-intervals (SDNN), root mean square of successive RR-interval differences (RMDDS), high-frequency power (HF-power), low-frequency power (LF-power), and LF/HF were measured. A multivariate mixed model was used and reliability was defined as acceptable by a coefficient of variance (CV) ≤15% and an intraclass correlation coefficient (ICC) ≥0.80. During time periods with fetal respiratory movements, the highest reliability was achieved. Intra- and inter-observer reliability measurements were very high (CV: 0-9%; ICC â‰§ 0.86). Within the same recording, SDNN and RMSSD achieved acceptable reliability (CV: 14-15%; ICC â‰§ 0.80). However, day-to-day reliability displayed high CV's. In time periods with fetal respiratory movements, as compared to periods with quiescence RMSSD and HF-power were higher (Ratio: 1.33-2.03) and LF/HF power lower (Ratio: 0.54). In periods with fetal body movements SDNN, RMSSD and HF-power were higher (Ratio: 1.27-1.65). In conclusion, time periods with fetal respiratory movements were associated with high reliability of FHRV analyses and the highest values of parameters supposed to represent vagal activity.


Assuntos
Sistema Nervoso Autônomo , Movimento Fetal , Arritmias Cardíacas , Feminino , Frequência Cardíaca/fisiologia , Frequência Cardíaca Fetal/fisiologia , Humanos , Gravidez , Reprodutibilidade dos Testes
12.
BMC Pregnancy Childbirth ; 22(1): 235, 2022 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-35317772

RESUMO

BACKGROUND: The AFFIRM intervention aimed to reduce stillbirth and neonatal deaths by increasing awareness of reduced fetal movements (RFM) and implementing a care pathway when women present with RFM. Although there is uncertainty regarding the clinical effectiveness of the intervention, the aim of this analysis was to evaluate the cost-effectiveness. METHODS: A stepped-wedge, cluster-randomised trial was conducted in thirty-three hospitals in the United Kingdom (UK) and Ireland. All women giving birth at the study sites during the analysis period were included in the study. The costs associated with implementing the intervention were estimated from audits of RFM attendances and electronic healthcare records. Trial data were used to estimate a cost per stillbirth prevented was for AFFIRM versus standard care. A decision analytic model was used to estimate the costs and number of perinatal deaths (stillbirths + early neonatal deaths) prevented if AFFIRM were rolled out across Great Britain for one year. Key assumptions were explored in sensitivity analyses. RESULTS: Direct costs to implement AFFIRM were an estimated £95,126 per 1,000 births. Compared to standard care, the cost per stillbirth prevented was estimated to be between £86,478 and being dominated (higher costs, no benefit). The estimated healthcare budget impact of implementing AFFIRM across Great Britain was a cost increase of £61,851,400/year. CONCLUSIONS: Perinatal deaths are relatively rare events in the UK which can increase uncertainty in economic evaluations. This evaluation estimated a plausible range of costs to prevent baby deaths which can inform policy decisions in maternity services. TRIAL REGISTRATION: The trial was registered with www. CLINICALTRIALS: gov , number NCT01777022 .


Assuntos
Conscientização , Movimento Fetal , Morte Perinatal/prevenção & controle , Gestantes/educação , Gestantes/psicologia , Cuidado Pré-Natal/métodos , Análise Custo-Benefício , Procedimentos Clínicos , Técnicas de Apoio para a Decisão , Feminino , Custos de Cuidados de Saúde , Pessoal de Saúde/educação , Humanos , Irlanda , Irlanda do Norte , Educação de Pacientes como Assunto , Gravidez , Cuidado Pré-Natal/economia , Natimorto , Reino Unido
13.
J Obstet Gynaecol ; 42(6): 2144-2150, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35170379

RESUMO

This study aimed to determine the effect of motivational video stimulation and nutrition on the non-stress test (NST). The sample of the study consisted of 360 pregnant women in total, including two experimental groups and one control group (120 pregnant women in each group). After the pregnant women in the study were divided into three groups at a 1:1:1 ratio with the computer-assisted random sampling method, the draw method was used to determine the experimental and control groups. The pregnant women in the first experimental group were allowed to consume cake and juice 30 min before the NST procedure. The pregnant women in the second experimental group were also allowed to consume cake and juice, while they were also shown a video with the content of development and changes in the mother and the foetus during pregnancy, with relaxing music, for about 15-20 min. There was no intervention made in the control group. The data were collected using a Participant Information Form and an NST Findings Registry Form which were created by the researchers based on their review of the relevant literature. The data were analysed using arithmetic means, percentage distributions, ANOVA, Bonferroni and chi-squared tests. It was found that the mean number of foetal movements and the mean number of accelerations in the cake + juice and motivational video groups were higher than those in the control group (p < 0.001). Besides, the pregnant women in the experimental groups were found to have more reactive NST results. As a result, it was determined that the motivational video and cake + juice interventions improved the movement of the foetus, the number of accelerations and the ratio of reactivity in NST, but the two interventions did not have any superiority over each other. It is recommended to offer cake and juice to pregnant women before NST or have them watch a motivational video during NST, for having good NST results.Impact statementWhat is already known about the topic? The false-positive rates of the NST, which enables monitoring foetal movements and foetal heart rates, are high. These false-positive rates of the NST lead to many obstetric complications, in addition to increasing the rates of cesarean-section deliveries. Recent studies showed that there are methods and factors that increase foetal movements and shorten the application period of the NST. It was identified that food intake, music therapy, foetal vibroacoustic and halogen light stimulation before the NST increases foetal movements and shortens the application period of the NST.What this paper adds? In the study, it was found that watching motivational videos and consuming cake and juice increased the number of foetal movements, the number of accelerations and the rate of reactive NST results, but the two interventions did not have superiority over each other.What are the implications of these findings for clinical practice and/or further research? In order to increase reactive NST rates, it is recommended that pregnant women consume cake and fruit juice before the procedure and watch a motivational video during the NST procedure.


Assuntos
Frequência Cardíaca Fetal , Musicoterapia , Feminino , Movimento Fetal , Feto , Humanos , Musicoterapia/métodos , Gravidez , Gestantes
14.
J Equine Vet Sci ; 112: 103891, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35143928

RESUMO

Intrauterine mobility of the fetal-amniotic unit is unique in equids among domestic species. Intrinsic activity begins as head nods on ∼ Day 40 (Day 0 = ovulation) and by Day 60 has progressed into intermittent subtle to vigorous head, neck, limb, and body movements. On Days 60-100, fetal mobility is maximal with traveling of the fetal-amniotic unit throughout an allantoic pool that encompasses the uterine horns, and uterine body. The fetus may be entirely within one uterine horn with the horn entrance closed behind it, and then may work through the entrance into the uterine body. Mobility gradually decreases after Day 100 with a decrease in relative quantity of allantoic fluid but intrinsic activity continues. Changes in each of fetal intrauterine location, presentation, and recumbency can occur frequently (e.g., 5-minutes intervals). About 80% of fetal mobility is from the propulsive effects of intrinsic fetal activities, and the remainder is from currents and shifts in the allantoic pool. The fluid currents are attributable to transient uterine constrictions that vary from 10 mm in width to the length of a uterine horn and to extrinsic mare and adjacent visceral activity. The fetus is tethered by a long umbilical cord attached at the mid-uterus allowing travel throughout an allantoic sac that involves the entire uterus. The mobile fetus seemingly practices the neuromuscular coordination that it will need during independent life. The theriogenologist can educate and fascinate onlookers by ultrasound demonstrations of bursts of fetal activity and mobility. An online video is included.


Assuntos
Feto , Útero , Alantoide , Animais , Feminino , Movimento Fetal , Cavalos , Ovulação
15.
BJOG ; 129(1): 29-41, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34555257

RESUMO

OBJECTIVE: The My Baby's Movements (MBM) trial aimed to evaluate the impact on stillbirth rates of a multifaceted awareness package (the MBM intervention). DESIGN: Stepped-wedge cluster-randomised controlled trial. SETTING: Twenty-seven maternity hospitals in Australia and New Zealand. POPULATION: Women with a singleton pregnancy without major fetal anomaly at ≥28 weeks of gestation from August 2016 to May 2019. METHODS: The MBM intervention was implemented at randomly assigned time points, with the sequential introduction of eight groups of between three and five hospitals at 4-monthly intervals. Using generalised linear mixed models, the stillbirth rate was compared in the control and the intervention periods, adjusting for calendar time, study population characteristics and hospital effects. MAIN OUTCOME MEASURES: Stillbirth at ≥28 weeks of gestation. RESULTS: There were 304 850 births with 290 105 births meeting the inclusion criteria: 150 053 in the control and 140 052 in the intervention periods. The stillbirth rate was lower (although not statistically significantly so) during the intervention compared with the control period (2.2/1000 versus 2.4/1000 births; aOR 1.18, 95% CI 0.93-1.50; P = 0.18). The decrease in stillbirth rate was greater across calendar time: 2.7/1000 in the first versus 2.0/1000 in the last 18 months. No increase in secondary outcomes, including obstetric intervention or adverse neonatal outcome, was evident. CONCLUSIONS: The MBM intervention did not reduce stillbirths beyond the downward trend over time. As a result of low uptake, the role of the intervention remains unclear, although the downward trend across time suggests some benefit in lowering the stillbirth rate. In this study setting, an awareness of the importance of fetal movements may have reached pregnant women and clinicians prior to the implementation of the intervention. TWEETABLE ABSTRACT: The My Baby's Movements intervention to raise awareness of decreased fetal movement did not significantly reduce stillbirth rates.


Assuntos
Movimento Fetal , Aceitação pelo Paciente de Cuidados de Saúde , Gestantes , Cuidado Pré-Natal , Natimorto/epidemiologia , Adulto , Austrália/epidemiologia , Feminino , Humanos , Nova Zelândia/epidemiologia , Gravidez , Terceiro Trimestre da Gravidez , Adulto Jovem
16.
J Obstet Gynaecol ; 42(1): 28-34, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33938348

RESUMO

The objective of our study was to investigate the possible relationship between poor perinatal outcome and foetal cardiac functions in pregnant women with reduced foetal movements (RFM). This cross-sectional study included 126 pregnant women with normal foetal movements (Group 1, Controls) and 42 pregnant women over 32 weeks gestation with RFM (Group 2). Group 2 was further divided into two subgroups according to their perinatal outcome: normal perinatal outcome (Group 2a) and poor perinatal outcome (Group 2b). Cardiotocography, the E/A ratio in both atrioventricular valves, myocardial performance index (MPI) and foetal tricuspid annular plane systolic excursion (f-TAPSE) were evaluated. Foetuses with poor perinatal outcome had a higher MPI (p = .003), higher tricuspid and mitral E/A (p < .001), and lower f-TAPSE values (p < .001). In regression analysis, f-TAPSE was the only parameter (p = .04) independently associated with poor perinatal outcome. In conclusion, examining f-TAPSE may predict adverse perinatal outcome in pregnancies with RFM.IMPACT STATEMENTWhat is already known on this subject? Reduced foetal movement (RFM) is associated with adverse pregnancy outcome. Cardiotocography, amniotic fluid assessment, estimated birthweight, foetal Doppler and formal foetal movement count (kick chart) are generally used in the clinical assessment of pregnancies with reduced foetal movements. These tests, we currently use to assess foetal wellbeing in women with reduced foetal movements, have limited sensitivity in predicting foetal compromise.What do the results of this study add? Foetal cardiac Doppler may potentially be used as an important adjunct to the conventional management of women with a perception of reduced foetal movements.What are the implications of these findings for clinical practice and/or further research? Foetal echocardiographic evaluation, such as f-TAPSE, may influence clinical practice by enabling improved risk stratification for poor perinatal outcome, thus allowing more timely definitive intervention. This could help to decrease the rate of stillbirth related to reduced foetal movements. The few established echocardiographically derived parameters, which can asses global right ventricle function, are not always easy to obtain, however, f-TAPSE is easily obtainable using ultrasound and it appears to be a clinically useful echocardiographic measurement of right ventricular function.


Assuntos
Ecocardiografia , Doenças Fetais/fisiopatologia , Coração Fetal/fisiopatologia , Movimento Fetal , Ultrassonografia Pré-Natal , Adulto , Estudos de Casos e Controles , Estudos Transversais , Feminino , Doenças Fetais/diagnóstico por imagem , Humanos , Gravidez , Resultado da Gravidez , Terceiro Trimestre da Gravidez
17.
J Matern Fetal Neonatal Med ; 35(10): 1923-1928, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-32495705

RESUMO

OBJECTIVE: The aim of this study was to evaluate the role of cerebroplacental ratio (CPR) in term pregnancies with reduced fetal movements (RFM) and appropriate for gestational age (AGA)fetuses to predict poor neonatal outcomes. METHODS: A prospective cohort study was performed on 150 singleton pregnancies with gestational age of 37-41 weeks and multiple episodes of RFM (case group) and 150 pregnancies within the same criteria only without RFM (control group). Both groups had appropriate for gestational age (AGA)fetuses. Umbilical artery (UA) and middle cerebral artery (MCA) pulsatility indices (PI) were measured, and MCA to UA ratio (CPR) was calculated. Doppler indices and neonatal outcomes were compared between the two groups. Independent prediction role of CPR MoM was evaluated through a binary logistic regression method. RESULTS: The RFM group had significantly higher UA- PI MoM (1.01 ± 0.19 versus 0.86 ± 0.05, p < .001), lower MCA MoM (1.28 ± 0.20 versus 1.40 ± 0.13, (p < .001)) and lower CPR MoM (0.98 ± 0.24 versus 1.23 ± 0.12, (p < .001)) compared to the control group. Mean umbilical artery pH was lower in the RFM group and the frequency of neonatal UA cord pH <7.2 was higher in the RFM group. In RFM group, CPR MoM showed a significant linear correlation with birth weight centiles (r = 0.244, p = .003), umbilical artery pH (r = 0.319, p < .001) and Apgar score at minute 1 (r = 0.332, p < .001). CPR MoM exhibited negative correlation with duration of NICU stay (r= -0.187, p = .022). No similar correlation was observed in the control group. In binary logistic regression analysis, CPR MoM was adjusted for the results of NST; and it was concluded that CPR MoM was the only significant predictor of Apgar score minute 1 = <7 (OR: 0.004; 95% CI: 0.0002-0.0673, p < .001), umbilical artery ph <7.2 (OR: 0.019; 95% CI: 0.00005-0.0423, p < .001) and NICU admission (OR: 0.116; 95% CI: 0.018-0.744, p = .023). In multivariate binary logistic regression analysis included parity, history of abortion and ART, AFI, BPP and CPR MoM; the AFI (OR: 0.976; 95% CI: 0.957-0.995, p = .014), BPP (OR: 0.306; 95% CI: 0.172-0.545, p < .001) and CPR MoM (OR: 0.00005 95% CI: 0.000003-0.00061, p < .001) were the significant predictor of RFM. Area under the curve in receiver operating characteristics (ROC) curve was calculated as 0.828 for CPR MoM as a predictor of RFM (SE: 0.024, p < .001), yielding sensitivity and specificity estimates of 80.0% and 65.0%, respectively, using an optimal cutoff level of = < 1.19. CONCLUSION: This study concluded that reduced fetal movement was significantly related to low CPR MOM. Also, it showed the independent role of CPR MoM for prediction of lower neonatal umbilical artery pH, lower Apgar score minute 1 and higher rate of NICU admission in AGA term fetuses without considering NST results. Also, AFI, BPP and CPR MoM are significant predictors of RFM.


Assuntos
Reanimação Cardiopulmonar , Movimento Fetal , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Artéria Cerebral Média/diagnóstico por imagem , Gravidez , Resultado da Gravidez , Estudos Prospectivos , Fluxo Pulsátil , Ultrassonografia Doppler , Ultrassonografia Pré-Natal/métodos , Artérias Umbilicais/diagnóstico por imagem
18.
J Perinat Med ; 50(6): 668-677, 2022 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-34261204

RESUMO

OBJECTIVES: Maternal report of reduced fetal movements (RFM) is a means of identifying fetal compromise in pregnancy. In live births RFM is associated with altered placental structure and function. Here, we explored associations between RFM, pregnancy characteristics, and the presence of placental abnormalities and fetal growth restriction (FGR) in cases of stillbirth. METHODS: A retrospective cohort study was carried out in a single UK tertiary maternity unit. Cases were divided into three groups: 109 women reporting RFM, 33 women with absent fetal movements (AFM) and 159 who did not report RFM before the diagnosis of stillbirth. Univariate and multivariate logistic regression was used to determine associations between RFM/AFM, pregnancy characteristics, placental insufficiency and the classification of the stillbirth. RESULTS: AFM or RFM were reported prior to diagnosis of stillbirth in 142 (47.2%) of cases. Pregnancies with RFM prior to diagnosis of stillbirth were independently associated with placental insufficiency (Odds Ratio (OR) 2.79, 95% Confidence Interval (CI) 1.84, 5.04) and were less frequently associated with maternal proteinuria (OR 0.16, 95% CI 0.07, 0.62) and previous pregnancy loss <24 weeks (OR 0.20, 95% CI 0.07, 0.70). When combined, AFM and RFM were less frequently reported in twin pregnancies ending in stillbirth and in intrapartum stillbirths. CONCLUSIONS: The association between RFM and placental insufficiency was confirmed in cases of stillbirth. This provides further evidence that RFM is a symptom of placental insufficiency. Therefore, investigation after RFM should aim to identify placental dysfunction.


Assuntos
Insuficiência Placentária , Feminino , Retardo do Crescimento Fetal/etiologia , Movimento Fetal , Humanos , Placenta , Gravidez , Estudos Retrospectivos , Natimorto/epidemiologia
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