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Obstetrics and gynaecology
Research
Alterations in maternally perceived fetal movement and their association with late stillbirth: findings from the Midland and North of England stillbirth case–control study
  1. Alexander E P Heazell1,2,
  2. Jayne Budd2,
  3. Minglan Li3,
  4. Robin Cronin3,
  5. Billie Bradford3,
  6. Lesley M E McCowan,
  7. Edwin A Mitchell4,
  8. Tomasina Stacey5,
  9. Bill Martin6,
  10. Devender Roberts7,8,
  11. John M D Thompson4
  1. 1 Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biological, Medical and Human Sciences, University of Manchester, Manchester, UK
  2. 2 Manchester Academic Health Science Centre, St. Mary’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
  3. 3 Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
  4. 4 Department of Paediatrics, Child Health and Youth Health, University of Auckland, Auckland, New Zealand
  5. 5 School of Healthcare, University of Leeds, Leeds, UK
  6. 6 Department of Obstetrics, Birmingham Women’s Hospital NHS Foundation Trust, Birmingham, UK
  7. 7 Department of Obstetrics, Liverpool Women’s NHS Foundation Trust, Liverpool, Liverpool, UK
  8. 8 Department of Obstetrics and Gynaecology, Liverpool Women’s Hospital NHS Foundation Trust, Liverpool, UK
  1. Correspondence to Dr Alexander E P Heazell; alexander.heazell{at}manchester.ac.uk

Abstract

Objective To report perception of fetal movements in women who experienced a stillbirth compared with controls at a similar gestation with a live birth.

Design Case–control study.

Setting 41 maternity units in the UK.

Participants Cases were women who had a late stillbirth ≥28 weeks gestation (n=291) and controls were women with an ongoing pregnancy at the time of the interview (n=733). Controls were frequency matched to cases by obstetric unit and gestational age.

Methods Data were collected using an interviewer-administered questionnaire which included questions on maternal perception of fetal movement (frequency, strength, increased and decreased movements and hiccups) in the 2 weeks before the interview/stillbirth. Five fetal movement patterns were identified incorporating the changes in strength and frequency in the last 2 weeks by combining groups of similar pattern and risk. Multivariable analysis adjusted for known confounders.

Primary outcome measure Association of maternally perceived fetal movements in relation to late stillbirth.

Results In multivariable analyses, women who reported increased strength of movements in the last 2 weeks had decreased risk of late stillbirth compared with those whose movements were unchanged (adjusted OR (aOR) 0.18, 95% CI 0.13 to 0.26). Women with decreased frequency (without increase in strength) of fetal movements were at increased risk (aOR 4.51, 95% CI 2.38 to 8.55). Daily perception of fetal hiccups was protective (aOR 0.31, 95% CI 0.17 to 0.56).

Conclusions Increased strength of fetal movements and fetal hiccups is associated with decreased risk of stillbirth. Alterations in frequency of fetal movements are important in identifying pregnancies at increased risk of stillbirth, with the greatest risk in women noting a reduction in fetal activity. Clinical guidance should be updated to reflect that increase in strength and frequency of fetal movements is associated with the lowest risk of stillbirth, and that decreased fetal movements are associated with stillbirth.

Trial registration number NCT02025530.

  • maternal perception
  • fetal movement
  • reduced fetal movement
  • exaggerated fetal movement
  • stillbirth
  • risk factor

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2017-020031

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    Footnotes

    • Contributors AEH, TS, BM, DR, EAM and LMEM contributed to all aspects of the study design and obtained funding. AEH had overall responsibility for the study. JB coordinated the running of the study. ML and JMDT analysed the data with input from AEH, JB, RC, BB, EAM and LMEM. All authors were responsible for the drafting of the manuscript. All authors gave approval for the final version of the manuscript.

    • Funding The Midland and North of England Stillbirth Study was funded by grant GN2156 from Action Medical Research, Cure Kids and Sands.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval This study was reviewed by NRES Committee North West—Greater Manchester Central Reference (13/NW/0874) on 24 January 2014.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data from the MiNESS study are available from a repository. Anonymised data are available on request to the corresponding author.