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Niu C, Xie Y, Zhou W, Ren Y, Zheng Y, Li L. Effect of social support on fetal movement self-monitoring behavior in Chinese women: a moderated mediation model of health beliefs. J Psychosom Obstet Gynaecol 2024; 45:2291632. [PMID: 38095324 DOI: 10.1080/0167482x.2023.2291632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE Strengthening the management of women's self-monitoring during pregnancy is important to reduce fetal death in utero and improve maternal and infant outcomes. However, due to the lack of awareness among pregnant women about the importance of self-monitoring fetal movement, resulting in low behavioral compliance, adverse pregnancy outcomes remain common in China. This study aimed to investigate the relationship between social support and health beliefs and the self-monitoring behavior of fetal movement. In addition, we examined the moderating and mediating effects of health beliefs on fetal movement self-monitoring. METHODS This cross-sectional study was conducted on 200 postpartum mothers in a tertiary hospital in China. The mothers were asked to complete a socio-demographic questionnaire, the fetal movement self-monitoring behavior questionnaire, the fetal movement self-monitoring health beliefs questionnaire, and the social support rating scale. Data from the questionnaires were analyzed and compared using SPSS 24.0 and PROCESS 3.2. RESULTS The results of this study showed that the total scores of social supports, health beliefs, fetal movement self-monitoring were 42.98 ± 11.65, 78.605 ± 13.73, and 11.635 ± 2.86, respectively. The study found that when social support and health beliefs were included in the regression equation, both social support and health beliefs showed a positive correlation with fetal movement self-monitoring. Health beliefs partially mediated the effect of social support on fetal movement self-monitoring, accounting for 37.5% of the total effect. CONCLUSION Social support and health beliefs play a crucial role in influencing the self-monitoring behavior of fetal movements. Therefore, strengthening social support and health beliefs during pregnancy has the potential to improve compliance with fetal movement self-monitoring behaviors for pregnant women.
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Affiliation(s)
- Changmin Niu
- School of Nursing·School of Public Health, Yangzhou University, Yangzhou, China
| | - Yue Xie
- School of Nursing·School of Public Health, Yangzhou University, Yangzhou, China
| | - Wangxuan Zhou
- School of Nursing·School of Public Health, Yangzhou University, Yangzhou, China
| | - Yue Ren
- School of Nursing·School of Public Health, Yangzhou University, Yangzhou, China
| | - Ying Zheng
- School of Nursing·School of Public Health, Yangzhou University, Yangzhou, China
| | - Lin Li
- Affiliated Hospital of Yangzhou University, Yangzhou, China
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Cohen G, Pinchas-Cohen T, Blickstein O, Ben Zion M, Schreiber H, Biron-Shental T, Shechter-Maor G. Are reduced fetal movements "merely" a maternal perception or truly a reflection of umbilical cord complications? A clinical trial. Int J Gynaecol Obstet 2024; 164:933-941. [PMID: 37688370 DOI: 10.1002/ijgo.15076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/31/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE To characterize obstetric outcomes and the association with umbilical cord (UC) complications among women complaining of reduced fetal movements (RFMs). METHODS This retrospective cohort compared women with a perception of RFMs within 2 weeks prior to delivery with women who reported no changes in fetal movements in terms of maternal characteristics and neonatal outcomes. A primary outcome of UC complications at delivery was defined. Multivariable regression analysis was performed to identify independent associations with RFMs and UC complications. RESULTS In all, 46 103 women were included, 2591 (5.6%) of whom reported RFMs and 43 512 (94.4%) in the control group. Compared with controls, the RFM group was more likely to be nulliparous (42.6% vs 32.2%, P < 0.001), smokers (6.4% vs 5.4%, P = 0.029), or obese (body mass index >30) (16.4% vs 11.6%, P < 0.001). They were also more likely to have an anterior placenta (56.2% vs 51.8%, P < 0.001) and poly/oligohydramnios (0.7% vs 0.4%, P = 0.015 and 3.6% vs 2.1%, P < 0.001, respectively). Induction of labor was more common in the RFM group (33.9% vs 19.7%, P < 0.001), as well as meconium (16.8% vs 15.0%, P = 0.026) and vacuum extractions (10.1% vs 8.0%, P < 0.001). Higher rates of stillbirth and the severe composite neonatal outcome were observed in the RFM group (1.5% vs 0.2%, P < 0.001 and 0.6% vs 0.3%, P = 0.010, respectively). The RFM group was characterized by higher rates of triple nuchal cord (P = 0.015), UC around body or neck (32.2% vs 29.6%, P = 0.010), and true knot (2.3% vs 1.4%, P = 0.002). Multivariable logistic regression found RFMs to be independently associated with triple nuchal cord and with a true cord knot. A sub-analysis including only cases of stillbirth (n = 127) revealed even higher rates of UC complications: 7% of all stillbirths presented with a true cord knot (20% true knots were found in stillbirths preceded by RFMs vs 6.1% in stillbirth cases without RFMs). Additionally, 33.8% of all stillbirths presented with nuchal cord (40% preceded by RFMs vs 33.3% without RFMs). CONCLUSIONS RFMs are associated with increased risk of UC complications observed at delivery, as well as increased risk of stillbirth and neonatal adverse outcomes.
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Affiliation(s)
- Gal Cohen
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tally Pinchas-Cohen
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
| | - Ophir Blickstein
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
| | - Maya Ben Zion
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hanoch Schreiber
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Shechter-Maor
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Clark JA, Smith LK, Armstrong N. Midwives' and obstetricians' practice, perspectives and experiences in relation to altered fetal movement: A focused ethnographic study. Int J Nurs Stud 2024; 150:104643. [PMID: 38043485 DOI: 10.1016/j.ijnurstu.2023.104643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Reducing avoidable stillbirth is a global priority. The stillbirth rate in England compares unfavourably to that of some other high-income countries. Poorly-managed episodes of altered fetal movement have been highlighted as a key contributor to avoidable stillbirth, and strategies introduced in England in 2016 to reduce perinatal mortality included recommendations for the management of reduced fetal movement. Despite a downward trend in stillbirth rates across the UK, the effects of policies promoting awareness of fetal movement remain uncertain. OBJECTIVE To provide in-depth knowledge of how practice and clinical guidance relating to altered fetal movement are perceived, enacted and experienced by midwives and obstetricians, and explore the relationship between recommended fetal movement care and actual fetal movement care. DESIGN A focused ethnographic approach comprising over 180 h of observation, 15 interviews, and document analysis was used to explore practice at two contrasting UK maternity units. SETTINGS Antenatal services at two UK maternity units, one in the Midlands and one in the North of England. PARTICIPANTS Thirty-six midwives, obstetricians and sonographers and 40 pregnant women participated in the study across 52 observed care episodes and relevant unit activity. Twelve midwives and three obstetricians additionally participated in formal semi-structured interviews. METHODS Fieldnotes, interview transcripts, policy documents, maternity notes and clinical guidelines were analysed using a modified constant comparison method to identify important themes. RESULTS fetal movement practice was mostly consistent and in line with guideline recommendations. Notwithstanding, most midwives and obstetricians had concerns about this area of care, including challenges in diagnosis, conflicting evidence about activity, heightened maternal anxiety, and high rates of monitoring and intervention in otherwise low-risk pregnancies. To address these issues, midwives spent considerable time reassuring women through information and regular monitoring, and coaching them to perceive fetal movement more accurately. CONCLUSIONS Practice relating to altered fetal movement might be more uniform than in the past. However, a heightened focus on fetal movement is associated by some midwives and obstetricians with potential harms, including increased anxiety in pregnancy, and high rates of monitoring and intervention in pregnancies where there are no 'objective concerns'. Challenges in diagnosing a significant change in fetal movement with accuracy might mean that interventions and resources are not being directed towards those pregnancies most at risk. More research is needed to determine how healthcare professionals can engage in conversations about fetal movement and stillbirth to support safe outcomes and positive experiences in pregnancy and birth. REGISTRATION Not registered. TWEETABLE ABSTRACT Midwives and obstetricians take #reducedfetalmovement seriously but worry this 'unreliable' symptom increases anxiety, monitoring and intervention in many 'low risk' pregnancies.
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Affiliation(s)
- Julia A Clark
- Department of Population Health Sciences, University of Leicester, Leicester, UK; School of Health Science, The University of Nottingham, Nottingham, UK.
| | - Lucy K Smith
- Department of Population Health Sciences, University of Leicester, Leicester, UK.
| | - Natalie Armstrong
- Department of Population Health Sciences, University of Leicester, Leicester, UK
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4
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Hayes DJL, Devane D, Dumville JC, Gordijn SJ, Smith V, Walsh T, Heazell AEP. Development of core outcome sets for studies relating to awareness and clinical management of reduced fetal movement. BJOG 2024; 131:64-70. [PMID: 37394688 DOI: 10.1111/1471-0528.17589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/26/2023] [Accepted: 06/13/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE This study aimed to create core outcome sets (COSs) for use in research studies relating to the awareness and clinical management of reduced fetal movement (RFM). DESIGN Delphi survey and consensus process. SETTING International. POPULATION A total of 128 participants (40 parents, 19 researchers and 65 clinicians) from 16 countries. METHODS A systematic literature review was conducted to identify outcomes in studies of interventions relating to the awareness and the clinical management of RFM. Using these outcomes as a preliminary list, stakeholders rated the importance of these outcomes for inclusion in COSs for studies of: (i) awareness of RFM; and (ii) clinical management of RFM. MAIN OUTCOME MEASURES Preliminary lists of outcomes were discussed at consensus meetings where two COSs (one for studies of RFM awareness and one for studies of clinical management of RFM). RESULTS The first round of the Delphi survey was completed by 128 participants, 66% of whom (n = 84) completed all three rounds. Fifty outcomes identified by the systematic review, after multiple definitions were combined, were voted on in round one. Two outcomes were added in round one, and as such 52 outcomes were voted on in two lists in rounds two and three. The COSs for studies of RFM awareness and clinical management are comprised of eight outcomes (four maternal and four neonatal) and 10 outcomes (two maternal and eight neonatal), respectively. CONCLUSIONS These COSs provide researchers with the minimum set of outcomes to be measured and reported in studies relating to the awareness and the clinical management of RFM.
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Affiliation(s)
- Dexter J L Hayes
- Tommy's Stillbirth Research Centre, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Declan Devane
- Health Research Board Trials Methodology Research Network, School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - Jo C Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Science Centre, University of Manchester, Manchester, UK
| | - Sanne J Gordijn
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Valerie Smith
- School of Nursing & Midwifery, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Tanya Walsh
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Alexander E P Heazell
- Tommy's Stillbirth Research Centre, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Niles KM, Jain V, Chan C, Choo S, Dore S, Kiely DJ, Lim K, Roy Lacroix ME, Sharma S, Waterman E. Guideline No. 441: Antenatal Fetal Health Surveillance. J Obstet Gynaecol Can 2023; 45:665-677.e3. [PMID: 37661122 DOI: 10.1016/j.jogc.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
OBJECTIVE To summarize the current evidence and to make recommendations for antenatal fetal health surveillance (FHS) to detect perinatal risk factors and potential fetal decompensation in the antenatal period and to allow for timely intervention to prevent perinatal morbidity and/or mortality. TARGET POPULATION Pregnant individuals with or without maternal, fetal, or pregnancy-associated perinatal risk factors for antenatal fetal decompensation. OPTIONS To use basic and/or advanced antenatal testing modalities, based on risk factors for potential fetal decompensation. OUTCOMES Early identification of potential fetal decompensation allows for interventions that may support fetal adaptation to maintain well-being or expedite delivery. BENEFITS, HARMS, AND COSTS Antenatal FHS in pregnant individuals with identified perinatal risk factors may reduce the chance of adverse outcomes. Given the high false-positive rate, FHS may increase unnecessary interventions, which may result in harm, including parental anxiety, premature or operative birth, and increased use of health care resources. Optimization of surveillance protocols based on evidence-informed practice may improve perinatal outcomes and reduce harm. EVIDENCE Medline, PubMed, Embase, and the Cochrane Library were searched from inception to January 2022, using medical subject headings (MeSH) and key words related to pregnancy, fetal monitoring, fetal movement, stillbirth, pregnancy complications, and fetal sonography. This document represents an abstraction of the evidence rather than a methodological review. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE All health care team members who provide care for or education to obstetrical patients, including maternal fetal medicine specialists, obstetricians, family physicians, midwives, nurses, nurse practitioners, and radiologists. SUMMARY STATEMENTS RECOMMENDATIONS.
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Han Q, Hao D, Yang L, Yang Y, Li G. Non-Contact Monitoring of Fetal Movement Using Abdominal Video Recording. Sensors (Basel) 2023; 23:4753. [PMID: 37430667 DOI: 10.3390/s23104753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 07/12/2023]
Abstract
Fetal movement (FM) is an important indicator of fetal health. However, the current methods of FM detection are unsuitable for ambulatory or long-term observation. This paper proposes a non-contact method for monitoring FM. We recorded abdominal videos from pregnant women and then detected the maternal abdominal region within each frame. FM signals were acquired by optical flow color-coding, ensemble empirical mode decomposition, energy ratio, and correlation analysis. FM spikes, indicating the occurrence of FMs, were recognized using the differential threshold method. FM parameters including number, interval, duration, and percentage were calculated, and good agreement was found with the manual labeling performed by the professionals, achieving true detection rate, positive predictive value, sensitivity, accuracy, and F1_score of 95.75%, 95.26%, 95.75%, 91.40%, and 95.50%, respectively. The changes in FM parameters with gestational week were consistent with pregnancy progress. In general, this study provides a novel contactless FM monitoring technology for use at home.
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Affiliation(s)
- Qiao Han
- Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
- Beijing International Science and Technology Cooperation Base for Intelligent Physiological Measurement and Clinical Transformation, Beijing 100124, China
| | - Dongmei Hao
- Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
- Beijing International Science and Technology Cooperation Base for Intelligent Physiological Measurement and Clinical Transformation, Beijing 100124, China
| | - Lin Yang
- Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
- Beijing International Science and Technology Cooperation Base for Intelligent Physiological Measurement and Clinical Transformation, Beijing 100124, China
| | - Yimin Yang
- Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
- Beijing International Science and Technology Cooperation Base for Intelligent Physiological Measurement and Clinical Transformation, Beijing 100124, China
| | - Guangfei Li
- Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
- Beijing International Science and Technology Cooperation Base for Intelligent Physiological Measurement and Clinical Transformation, Beijing 100124, China
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Alim A, Imtiaz MH. Wearable Sensors for the Monitoring of Maternal Health-A Systematic Review. Sensors (Basel) 2023; 23:2411. [PMID: 36904615 PMCID: PMC10007071 DOI: 10.3390/s23052411] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 06/18/2023]
Abstract
Maternal health includes health during pregnancy and childbirth. Each stage during pregnancy should be a positive experience, ensuring that women and their babies reach their full potential in health and well-being. However, this cannot always be achieved. According to UNFPA (United Nations Population Fund), approximately 800 women die every day from avoidable causes related to pregnancy and childbirth, so it is important to monitor mother and fetal health throughout the pregnancy. Many wearable sensors and devices have been developed to monitor both fetal and the mother's health and physical activities and reduce risk during pregnancy. Some wearables monitor fetal ECG or heart rate and movement, while others focus on the mother's health and physical activities. This study presents a systematic review of these analyses. Twelve scientific articles were reviewed to address three research questions oriented to (1) sensors and method of data acquisition; (2) processing methods of the acquired data; and (3) detection of the activities or movements of the fetus or the mother. Based on these findings, we discuss how sensors can help effectively monitor maternal and fetal health during pregnancy. We have observed that most of the wearable sensors were used in a controlled environment. These sensors need more testing in free-living conditions and to be employed for continuous monitoring before being recommended for mass implementation.
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8
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Yonaga Y, Ryo E, Yatsuki K, Kamata H, Ito A. Effect of ritodrine hydrochloride infusion on fetal movement with the use of a fetal movement acceleration measurement recorder (FMAM recorder). J Obstet Gynaecol Res 2023; 49:606-613. [PMID: 36443932 DOI: 10.1111/jog.15512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 10/23/2022] [Accepted: 11/13/2022] [Indexed: 12/03/2022]
Abstract
AIM To investigate the effect of ritodrine hydrochloride infusion on fetal movement. METHOD We gathered 20 pregnant women who received ritodrine hydrochloride infusion as the treated group, and 147 pregnant women who did not as the control group. All women recorded gross fetal movement with the fetal movement acceleration measurement recorder after 28 gestational weeks. The record was divided into epochs of 10 s, and the ratio of movement-positive epochs to all epochs was calculated as the fetal movement index. Furthermore, the mean duration and the mean number per hour of no-fetal movement period, where the fetus did not move for 5 min or more, were calculated as the indexes of no-fetal movement. All indexes were compared between the two groups at 28-31 and 32-35 gestational weeks. RESULTS The fetal movement indexes (%) were 17.29 ± 7.46 (mean ± SD) in the control group and 13.65 ± 7.13 in the treated group at 28-31 weeks (p = 0.139). At 32-35 weeks, they were 14.55 ± 6.43 and 18.50 ± 5.33, respectively (p = 0.03). Similarly, the no-fetal movement indexes (min, times/h) were 15.03 ± 10.99 and 1.61 ± 0.88, and 18.70 ± 15.80 and 1.75 ± 0.96 (p = 0.824, and 0.673) at 28-31 weeks. At 32-35 weeks, they were 18.13 ± 10.88 and 1.95 ± 0.97, and 9.20 ± 5.51 and 1.14 ± 0.71, respectively (p = 0.003, and 0.003). CONCLUSION Ritodrine hydrochloride infusion increased the fetal movement and decreased the no-fetal movement period at 32-35 weeks.
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Affiliation(s)
- Yuriko Yonaga
- Faculty of Pharmaceutical Sciences Teikyo Heisei University, Tokyo, Japan.,Department of Obstetrics and Gynecology, School of Medicine, Teikyo University, Tokyo, Japan
| | - Eiji Ryo
- Department of Obstetrics and Gynecology, School of Medicine, Teikyo University, Tokyo, Japan
| | - Keita Yatsuki
- Department of Obstetrics and Gynecology, School of Medicine, Teikyo University, Tokyo, Japan
| | - Hideo Kamata
- Department of Obstetrics and Gynecology, School of Medicine, Teikyo University, Tokyo, Japan
| | - Akihiko Ito
- Faculty of Pharmaceutical Sciences Teikyo Heisei University, Tokyo, Japan
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Skalecki S, Lawford H, Gardener G, Coory M, Bradford B, Warrilow K, Wojcieszek AM, Newth T, Weller M, Said JM, Boyle FM, East C, Gordon A, Middleton P, Ellwood D, Flenady V. My Baby's Movements: An assessment of the effectiveness of the My Baby's Movements phone program in reducing late-gestation stillbirth rates. Aust N Z J Obstet Gynaecol 2023. [PMID: 36717966 DOI: 10.1111/ajo.13647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/02/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Delayed reporting of decreased fetal movements (DFM) could represent a missed opportunity to prevent stillbirth. Mobile phone applications (apps) have the potential to improve maternal awareness and reporting of DFM and contribute to stillbirth prevention. AIMS To evaluate the effectiveness of the My Baby's Movements (MBM) app on late-gestation stillbirth rates. MATERIALS AND METHODS The MBM trial evaluated a multifaceted fetal movements awareness package across 26 maternity services in Australia and New Zealand between 2016 and 2019. In this secondary analysis, generalised linear mixed models were used to compare rates of late-gestation stillbirth, obstetric interventions, and neonatal outcomes between app users and non-app users including calendar time, cluster, primiparity and other potential confounders as fixed effects, and hospital as a random effect. RESULTS Of 140 052 women included, app users comprised 9.8% (n = 13 780). The stillbirth rate was not significantly lower among app users (1.67/1000 vs 2.29/1000) (adjusted odds ratio (aOR) 0.79; 95% CI 0.51-1.23). App users were less likely to have a preterm birth (aOR 0.81; 0.75-0.88) or a composite adverse neonatal outcome (aOR 0.87; 0.81-0.93); however, they had higher rates of induction of labour (IOL) (aOR 1.27; 1.22-1.32) and early term birth (aOR 1.08; 1.04-1.12). CONCLUSIONS The MBM app had low uptake and its use was not associated with stillbirth rates but was associated with some neonatal benefit, and higher rates of IOL and early term birth. Use and acceptability of tools designed to promote fetal movement awareness is an important knowledge gap. The implications of increased IOL and early term births warrant consideration in future studies.
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Affiliation(s)
- Sarah Skalecki
- Department of Maternal Fetal Medicine, Mater Misericordiae Limited, Brisbane, Queensland, Australia
| | - Harriet Lawford
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Glenn Gardener
- Department of Maternal Fetal Medicine, Mater Misericordiae Limited, Brisbane, Queensland, Australia
| | - Michael Coory
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Billie Bradford
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Kara Warrilow
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Aleena M Wojcieszek
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Tionie Newth
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Megan Weller
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Joanne M Said
- University of Melbourne, Melbourne, Victoria, Australia.,Western Health, Sunshine Hospital, Melbourne, Victoria, Australia
| | - Fran M Boyle
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Christine East
- Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Adrienne Gordon
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Philippa Middleton
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.,SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - David Ellwood
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.,Gold Coast University Hospital, Southport, Queensland, Australia.,School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Vicki Flenady
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
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10
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Liu Y, Xuan R, He Y, Ren F, Gu Y. Computation of Fetal Kicking in Various Fetal Health Examinations: A Systematic Review. Int J Environ Res Public Health 2022; 19:4366. [PMID: 35410056 DOI: 10.3390/ijerph19074366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/28/2022] [Accepted: 04/02/2022] [Indexed: 11/16/2022]
Abstract
Fetal movement has always been considered an essential indicator to evaluate the health of the unborn fetus. Many factors affect fetal movement. The frequency of fetal kicking is an important measurement of whether fetal development is progressing and healthy. Various instruments and methods of detecting fetal movement have been used and each method has its advantages and disadvantages. Although limited by the fetal environment in utero, the finite element method and musculoskeletal model can be used to calculate fetal lower limb movement. This review aims to summarize the current detection techniques for fetal movement, especially in the lower limbs. These will be outlined by describing the different measurements of fetal movement, and the related biomechanical analyses of fetal lower limb skeletogenesis and the associated muscular development to better evaluate and calculate the movements of the fetus in the womb.
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11
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Widiasih R, Hidayat D, Zakaria H, Utama DQ, Komariah M, Maryam NNA, Arifin H, Agustina HS, Nelson K. Self-Fetal Wellbeing Monitoring and Ante-Natal Care during the COVID-19 Pandemic: A Qualitative Descriptive Study among Pregnant Women in Indonesia. Int J Environ Res Public Health 2021; 18:11672. [PMID: 34770186 PMCID: PMC8583541 DOI: 10.3390/ijerph182111672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/28/2021] [Accepted: 11/02/2021] [Indexed: 11/29/2022]
Abstract
Pregnant women are expected to have a high level of awareness when it comes to checking their fetal health and ensuring their welfare. This study explored the experiences of pregnant women in Indonesia who were monitoring their fetal wellbeing during the COVID-19 pandemic. A qualitativedescriptive study design with a constructivist paradigm was used. Twenty-two pregnant women were recruited and participated in a semi-structured interview. Analysis of the transcribed interviews used a content, thematic and comparative process. Three themes emerged from the analysis: feelingsand responses, changes to the ante natal care service during the COVID-19 pandemic, and the fetal wellbeing monitoring, tools, and methods used. Advice on how pregnant women should conduct fetal wellbeing monitoring during COVID-19 is urgently needed. The results of this study indicate there is a need for interventions to help pregnant women carry out self-fetal wellbeing monitoring in times where they have fewer contacts with health professionals such as during the COVID-19 pandemic.
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Affiliation(s)
- Restuning Widiasih
- Department of Maternity Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung 45363, Indonesia
| | - Dini Hidayat
- General Hospital of Hasan Sadikin, Bandung 40161, Indonesia;
| | - Hasballah Zakaria
- Institut Teknologi Bandung, Bandung 40116, Indonesia; (H.Z.); (D.Q.U.)
| | - Dody Qori Utama
- Institut Teknologi Bandung, Bandung 40116, Indonesia; (H.Z.); (D.Q.U.)
| | - Maria Komariah
- Department of Fundamental Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung 45363, Indonesia;
| | | | - Hidayat Arifin
- Department of Medical Surgical Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung 45363, Indonesia;
| | - Habsyah Saparidah Agustina
- Department of Mental Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung 45363, Indonesia;
| | - Katherine Nelson
- School of Nursing, Midwifery, and Health Practice, Victoria University of Wellington, Wellington 6021, New Zealand;
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Chen H, Song Y, Xuan R, Hu Q, Baker JS, Gu Y. Kinematic Comparison on Lower Limb Kicking Action of Fetuses in Different Gestational Weeks: A Pilot Study. Healthcare (Basel) 2021; 9:1057. [PMID: 34442194 DOI: 10.3390/healthcare9081057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/03/2021] [Accepted: 08/16/2021] [Indexed: 12/04/2022] Open
Abstract
The fetal movements during different gestational weeks are essential for normal musculoskeletal development. The kinematic characteristics of fetuses with small differences in gestational weeks may be different and important. Ultrasonographic videos of fetal kicking action and plantarflexion action were collected from three healthy pregnant women (24, 27, and 30 gestational weeks) with normal fetal development. The kinematic characteristics, including angular range and angular velocity, were analyzed. These kinematic parameters were measured using simi motion. The final knee angle was found to decrease with progressive gestational weeks. Compared with 24 w, the knee joint angle at 27 w and 30 w was significantly reduced at the end of a kick-type movement (p < 0.01). Except for the mean angular velocity of the knee joint, there were no significant differences in the other conditions. The value at 30 w for mean angular velocity was significantly higher than that at 24 w (p = 0.02). In the ankle joint, no significant differences were observed between different conditions. Therefore, we can conclude that there was no significant difference in the kinematic characteristics of the ankle joint for small gestational age gaps, but there was a significant difference in the knee joint. As the gestation weeks increase, the range of kicking motion tends to decrease. The reason may be that with the increase of gestational weeks, fetal lower limb musculoskeletal development is gradually enhanced; the slower growth rate indicates that development reaches a peak level in weeks 24 to 30.
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Lucchini M, Shuffrey LC, Nugent JD, Pini N, Sania A, Shair M, Brink L, du Plessis C, Odendaal HJ, Nelson ME, Friedrich C, Angal J, Elliott AJ, Groenewald CA, Burd LT, Myers MM, Fifer WP. Effects of Prenatal Exposure to Alcohol and Smoking on Fetal Heart Rate and Movement Regulation. Front Physiol 2021; 12:594605. [PMID: 34400909 PMCID: PMC8363599 DOI: 10.3389/fphys.2021.594605] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
Negative associations of prenatal tobacco and alcohol exposure (PTE and PAE) on birth outcomes and childhood development have been well documented, but less is known about underlying mechanisms. A possible pathway for the adverse fetal outcomes associated with PTE and PAE is the alteration of fetal autonomic nervous system development. This study assessed PTE and PAE effects on measures of fetal autonomic regulation, as quantified by heart rate (HR), heart rate variability (SD-HR), movement, and HR-movement coupling in a population of fetuses at ≥ 34 weeks gestational age. Participants are a subset of the Safe Passage Study, a prospective cohort study that enrolled pregnant women from clinical sites in Cape Town, South Africa, and the Northern Plains region, United States. PAE was defined by six levels: no alcohol, low quit early, high quit early, low continuous, moderate continuous, and high continuous; while PTE by 4 levels: no smoking, quit early, low continuous, and moderate/high continuous. Linear regression analyses of autonomic measures were employed controlling for fetal sex, gestational age at assessment, site, maternal education, household crowding, and depression. Analyses were also stratified by sleep state (1F and 2F) and site (South Africa, N = 4025, Northern Plains, N = 2466). The final sample included 6491 maternal-fetal-dyad assessed in the third trimester [35.21 ± 1.26 (mean ± SD) weeks gestation]. PTE was associated with a decrease in mean HR in state 2F, in a dose dependent fashion, only for fetuses of mothers who continued smoking after the first trimester. In state 1F, there was a significant increase in mean HR in fetuses whose mother quit during the first trimester. This effect was driven by the Norther Plains cohort. PTE was also associated with a significant reduction in fetal movement in the most highly exposed group. In South Africa a significant increase in mean HR both for the high quit early and the high continuous group was observed. In conclusion, this investigation addresses a critical knowledge gap regarding the relationship between PTE and PAE and fetal autonomic regulation. We believe these results can contribute to elucidating mechanisms underlying risk for adverse outcomes.
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Affiliation(s)
- Maristella Lucchini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, United States
| | - Lauren C. Shuffrey
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, United States
| | - J. David Nugent
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, United States
| | - Nicoló Pini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, United States
| | - Ayesha Sania
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Margaret Shair
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, United States
| | - Lucy Brink
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
| | - Carlie du Plessis
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
| | - Hein J. Odendaal
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
| | - Morgan E. Nelson
- Center for Pediatric and Community Research, Avera Research Institute, Sioux Falls, SD, United States
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, United States
| | - Christa Friedrich
- Center for Pediatric and Community Research, Avera Research Institute, Sioux Falls, SD, United States
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, United States
| | - Jyoti Angal
- Center for Pediatric and Community Research, Avera Research Institute, Sioux Falls, SD, United States
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, United States
| | - Amy J. Elliott
- Center for Pediatric and Community Research, Avera Research Institute, Sioux Falls, SD, United States
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, United States
| | - Coen A. Groenewald
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, United States
| | - Larry T. Burd
- Department of Pediatrics, University of North Dakota Medical School, Grand Forks, ND, United States
| | - Michael M. Myers
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, United States
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States
| | - William P. Fifer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, United States
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States
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Abstract
OBJECTIVE To present evidence and recommendations regarding use, classification, interpretation, response, and documentation of fetal surveillance in the intrapartum period and to provide information to help minimize the risk of birth asphyxia while maintaining the lowest possible rate of obstetrical intervention. INTENDED USERS Members of intrapartum care teams, including but not limited to obstetricians, family physicians, midwives and nurses, and their learners TARGET POPULATION: Intrapartum women OPTIONS: All methods of uterine activity assessment and fetal heart rate surveillance were considered in developing this document. OUTCOMES The impact, benefits, and risks of different methods of surveillance on the diverse maternal-fetal health conditions have been reviewed based on current evidence and expert opinion. No fetal surveillance method will provide 100% detection of fetal compromise; thus, all FHS methods are viewed as screening tests. As the evidence continues to evolve, caregivers from all disciplines are encouraged to attend evidence-based Canadian educational programs every 2 years. EVIDENCE Literature published between January 1976 and February 2019 was reviewed. Medline, the Cochrane Database, and international guidelines were used to search the literature for all studies on intrapartum fetal surveillance. VALIDATION METHODS The principal and contributing authors agreed to the content and recommendations. The Board of the Society of Obstetricians and Gynaecologists of Canada approved the final draft for publication. The level of evidence has been determined using the criteria and classifications of the Canadian Task Force on Preventive Health Care. BENEFITS, HARM, AND COSTS Consistent interdisciplinary use of the guideline, appropriate equipment, and trained professional staff enhances safe intrapartum care. Women and their support person(s) should be informed of the benefits and harms of different methods of fetal health surveillance. RECOMMENDATIONS CommunicationSupport During Active LabourPrinciples of Intrapartum Fetal SurveillanceSelecting the Method of Fetal Heart Rate Monitoring: Intermittent Auscultation or Electronic Fetal MonitoringPaper SpeedAdmission AssessmentsEpidural AnalgesiaIntermittent Auscultation in LabourElectronic Fetal Monitoring in LabourClassification of Intrapartum Fetal SurveillanceMaternal Heart RateFetal Health Surveillance Assessment in the Active Second Stage of LabourIntrauterine ResuscitationDigital Fetal Scalp StimulationFetal Scalp Blood SamplingUmbilical Cord Blood GasesDocumentationFetal Surveillance Technology Not RecommendedFetal Health Surveillance Education.
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Chan L, Gordon A, Warrilow K, Wojcieszek A, Firth T, Loxton F, Bauman A, Flenady V. Evaluation of Movements Matter: A social media and hospital-based campaign aimed at raising awareness of decreased fetal movements. Aust N Z J Obstet Gynaecol 2021; 61:846-854. [PMID: 33908059 DOI: 10.1111/ajo.13360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/24/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Movements Matter campaign aimed to raise awareness of decreased fetal movements (DFM) among pregnant women and inform clinicians of best practice management. AIM To conduct a process evaluation of campaign implementation, and an impact evaluation of the campaign's effects on knowledge and experiences of pregnant women, and attitudes and practices of clinicians in relation to DFM. METHODS This study used a cross-sectional before-after design. Pregnant women and clinicians were sampled at five hospitals. Women were surveyed about their knowledge of DFM, and actions to take if they noticed DFM. Clinicians were asked about their current practices and attitudes about informing women about DFM. Logistic regression was used to calculate campaign effects on outcome measures. RESULTS The Movements Matter campaign reached 653 262 people on social media, as well as being covered on news media and popular women's websites. The evaluation surveyed 1142 pregnant women pre-campaign and 473 post-campaign, and 372 clinicians pre-campaign and 149 post-campaign. Following the campaign, women were more likely to be aware that babies should move the same amount in late pregnancy (adjusted odds ratio (aOR) 1.81, 95% CI 1.43-2.27), and were more likely to contact their health service immediately if their baby was moving less (aOR 1.52, 95% CI 1.22-1.91). Clinicians were 2.84 times more likely to recommend women should come in for assessment if they experience DFM (95% CI 1.35-5.97). CONCLUSIONS This evaluation has shown that a campaign using social media and in-hospital education materials led to some increases in knowledge about fetal movements among pregnant women.
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Affiliation(s)
- Lilian Chan
- Prevention Research Collaboration, Sydney School of Public Health and Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Adrienne Gordon
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Kara Warrilow
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Aleena Wojcieszek
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Tracy Firth
- Maternity and Newborn Clinical Network, Safer Care Victoria, Melbourne, Victoria, Australia
| | - Felicity Loxton
- Centres of Clinical Excellence, Safer Care Victoria, Melbourne, Victoria, Australia
| | - Adrian Bauman
- Prevention Research Collaboration, Sydney School of Public Health and Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Vicki Flenady
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
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Bezhenar VF, Ivanova LA, Belitchenko NV. [Comparative evaluation of ultrasonic virtopsia and classical autopsy for antenatal fetal death]. Arkh Patol 2020; 82:51-54. [PMID: 32593267 DOI: 10.17116/patol20208203151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM OF STUDY Comparison of the data obtained by ultrasound examination of a pregnant woman with antenatal death of the fetus and stillborn child, with the autopsy results. MATERIALS AND METHODS The protocols of ultrasound examinations and the autopsy protocols of 126 fetuses that died antenatally were analyzed. RESULTS In our study of 126 patients, 95 showed no structural changes either during ultrasound examination or during further pathomorphological examination. The ultrasound conclusion corresponded to the results of classical autopsy in the presence of congenital malformations in two patients. 29 pregnant women had discrepancies in the results of ultrasound examination and subsequent pathomorphological examination. At the same time, in 7 patients there was an overdiagnosis, in 22 - an underdiagnosis. CONCLUSIONS Ultrasound diagnostics in cases of suspected fetal death does not allow verification of the diagnosis, ultrasound examination of a pregnant woman with antenatal fetal death and post-mortem ultrasound examination of a stillborn cannot replace autopsy, pathoanatomical and histological examinations.
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Affiliation(s)
- V F Bezhenar
- First St. Petersburg State Medical University named after Acad. I.P. Pavlov, St. Petersburg, Russia
| | - L A Ivanova
- Military Medical Academy named after S.M. Kirov, St. Petersburg, Russia
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Sharp I, Adeyeye T, Peacock L, Mahdi A, Farrant K, Sharp AN, Greenwood SL, Heazell AEP. Investigation of the outcome of pregnancies complicated by increased fetal movements and their relation to underlying causes - A prospective cohort study. Acta Obstet Gynecol Scand 2020; 100:91-100. [PMID: 32683676 DOI: 10.1111/aogs.13961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Retrospective studies have reported an association between a single episode of significantly increased fetal movements (IFMs) and stillbirth after 28 weeks' gestation. This prospective study aimed to report the outcome of pregnancies associated with maternal perception of IFMs and determine whether this symptom is associated with adverse pregnancy outcome, a pathological intrauterine environment or placental dysfunction. MATERIAL AND METHODS Women reporting IFMs after 28 weeks' gestation were recruited from St Mary's Hospital, Manchester and Liverpool Women's Hospital, UK, between 1 November 2017 and 1 May 2019. Demographic and clinical information were obtained and an ultrasound scan was performed to assess fetal biometry, liquor volume and umbilical artery Doppler. Maternal serum samples were collected for analysis of placentally derived biomarkers using ELISA. After delivery, maternal and fetal outcome data were collected and placentas and umbilical cord blood were obtained for analysis using immunohistochemistry and ELISA, respectively. Placental and serum samples were matched by gestation and maternal characteristics to participants with normal fetal activity. RESULTS Seventy-seven women presented with IFM, representing 0.45% of the maternity population; 64 women consented to participate in the study, of which 7 (10.9%) experienced adverse pregnancy outcome: birthweight <3rd centile, 2 (3.1%); pH ≤7.10, 1 (1.6%); neonatal intensive care unit admission, 4 (6.3%). Women had IFM for varying lengths of time before presenting: 17.2% had IFM for less than 1 hour and 29.7% reported IFM lasting longer than 24 hours. Four women (6.3%) had abnormalities of the fetal heart rate trace on assessment. Women with IFM had similar modes of birth to women giving birth in participating maternity units. There was no evidence of macroscopic placental or umbilical cord abnormalities, alterations in microscopic placental structure, placental endocrine dysfunction or intrauterine hypoxia or infection in women with IFM compared with controls. CONCLUSIONS This prospective study did not find evidence of an association between IFM and adverse pregnancy outcome. It also did not find evidence of underlying placental dysfunction, cord anomalies, intrauterine hypoxia or infection in pregnancies with IFM. Further work is required to determine the strength of association between IFM and adverse pregnancy outcome and its origins. At present, IFM cannot be used to identify fetuses at increased risk of adverse outcome.
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Affiliation(s)
- Imogen Sharp
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biological, Medical and Health, University of Manchester, Manchester, UK
| | - Temidayo Adeyeye
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biological, Medical and Health, University of Manchester, Manchester, UK
| | - Linda Peacock
- St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Amy Mahdi
- Liverpool Women's Hospital, Liverpool, UK
| | - Kimberley Farrant
- St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Andrew N Sharp
- Liverpool Women's Hospital, Liverpool, UK.,Harris-Wellbeing Research Centre, University of Liverpool, Women's NHS Foundation Trust, Liverpool, UK
| | - Susan L Greenwood
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biological, Medical and Health, University of Manchester, Manchester, UK
| | - Alexander E P Heazell
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biological, Medical and Health, University of Manchester, Manchester, UK.,St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Abstract
Introduction: Counting of fetal movement (FM) during pregnancy is believed to be a method by which a woman estimates the fetal well-being. In 2015, it was estimated that 2.6 million babies had died in utero. A percentage of 30-55% of women who experience an episode of reduced fetal movement (RFM) within a week may face stillbirth. Aim: The aim of this review was to assess the impact of reduced fetal movements and of educational interventions on maternal counting of fetal movements on perinatal mortality, perinatal outcome and mode of delivery. Methods: A search of electronic databases was conducted for detecting studies that examine the coincidence of reduced fetal movements (RFM) in combination with stillbirth and perinatal morbidity. Results: The findings of this review suggest that there is an association between the incidence of stillbirth and the experience of alterations in fetal movements’ quantity and quality in the preceding weeks. Interventions on fetal movement counting, concerning both the number and the density of fetal movements, may reduce the adverse perinatal outcomes to an extent, after informing and making aware of the pregnant women for their meaning. Conclusion: Maternity care professionals should: a) inform pregnant women about the importance of FM counting, b) encourage pregnant women to be familiarized on the recognition of theirs’ baby normal pattern of fetal movements and c) alarm women when this pattern changes. Care professionals should emphasize that counting of fetal movements is not related only to movements’ quantity (number) but also to movements’ quality (density).
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Abstract
OBJECTIVE This guideline provides new recommendations pertaining to the application and documentation of fetal surveillance in the intrapartum period that will decrease the incidence of birth asphyxia while maintaining the lowest possible rate of obstetrical intervention. Pregnancies with and without risk factors for adverse perinatal outcomes are considered. This guideline presents an alternative classification system for antenatal fetal non-stress testing and intrapartum electronic fetal surveillance to what has been used previously. This guideline is intended for use by all health professionals who provide intrapartum care in Canada. OPTIONS Consideration has been given to all methods of fetal surveillance currently available in Canada. OUTCOMES Short- and long-term outcomes that may indicate the presence of birth asphyxia were considered. The associated rates of operative and other labour interventions were also considered. EVIDENCE A comprehensive review of randomized controlled trials published between January 1996 and March 2007 was undertaken, and MEDLINE and the Cochrane Database were used to search the literature for all new studies on fetal surveillance antepartum. The level of evidence has been determined using the criteria and classifications of the Canadian Task Force on Preventive Health Care (Table 1). SPONSOR This consensus guideline was jointly developed by the Society of Obstetricians and Gynaecologists of Canada and the British Columbia Perinatal Health Program (formerly the British Columbia Reproductive Care Program or BCRCP) and was partly supported by an unrestricted educational grant from the British Columbia Perinatal Health Program. RECOMMENDATION 1: LABOUR SUPPORT DURING ACTIVE LABOUR: RECOMMENDATION 2: PROFESSIONAL ONE-TO ONE CARE AND INTRAPARTUM FETAL SURVEILLANCE: RECOMMENDATION 3: INTERMITTENT AUSCULTATION IN LABOUR: RECOMMENDATION 4: ADMISSION FETAL HEART TEST: RECOMMENDATION 5: INTRAPARTUM FETAL SURVEILLANCE FOR WOMEN WITH RISK FACTORS FOR ADVERSE PERINATAL OUTCOME: When a normal tracing is identified, it may be appropriate to interrupt the electronic fetal monitoring tracing for up to 30 minutes to facilitate periods of ambulation, bathing, or position change, providing that (1) the maternal-fetal condition is stable and (2) if oxytocin is being administered, the infusion rate is not increased (III-B). RECOMMENDATION 6: DIGITAL FETAL SCALP STIMULATION: RECOMMENDATION 7: FETAL SCALP BLOOD SAMPLING: RECOMMENDATION 8: UMBILICAL CORD BLOOD GASES: RECOMMENDATION 9: FETAL PULSE OXIMETRY: RECOMMENDATION 10: ST WAVEFORM ANALYSIS: RECOMMENDATION 11: INTRAPARTUM FETAL SCALP LACTATE TESTING.
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Abstract
OBJECTIVE This guideline provides new recommendations pertaining to the application and documentation of fetal surveillance in the antepartum period that will decrease the incidence of birth asphyxia while maintaining the lowest possible rate of obstetrical intervention. Pregnancies with and without risk factors for adverse perinatal outcomes are considered. This guideline presents an alternative classification system for antenatal fetal non-stress testing to what has been used previously. This guideline is intended for use by all health professionals who provide antepartum care in Canada. OPTIONS Consideration has been given to all methods of fetal surveillance currently available in Canada. OUTCOMES Short- and long-term outcomes that may indicate the presence of birth asphyxia were considered. The associated rates of operative and other labour interventions were also considered. EVIDENCE A comprehensive review of randomized controlled trials published between January 1996 and March 2007 was undertaken, and MEDLINE and the Cochrane Database were used to search the literature for all new studies on fetal surveillance antepartum. The level of evidence has been determined using the criteria and classifications of the Canadian Task Force on Preventive Health Care (Table 1). SPONSOR This consensus guideline was jointly developed by the Society of Obstetricians and Gynaecologists of Canada and the British Columbia Perinatal Health Program (formerly the British Columbia Reproductive Care Program or BCRCP) and was partly supported by an unrestricted educational grant from the British Columbia Perinatal Health Program. RECOMMENDATION 1: FETAL MOVEMENT COUNTING: RECOMMENDATION 2: NON-STRESS TEST: RECOMMENDATION 3: CONTRACTION STRESS TEST: RECOMMENDATION 4: BIOPHYSICAL PROFILE: RECOMMENDATION 5: UTERINE ARTERY DOPPLER: RECOMMENDATION 6: UMBILICAL ARTERY DOPPLER.
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Liston R, Sawchuck D, Young D. No. 197c-Maintaining Standards in Antenatal and Intrapartum Fetal Surveillance: Quality Improvement and Risk Management. J Obstet Gynaecol Can 2019; 40:e353-e358. [PMID: 29680086 DOI: 10.1016/j.jogc.2018.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Liston R, Sawchuck D, Young D. N° 197b-Surveillance du bien-être fœtal : Directive consensus d'intrapartum. J Obstet Gynaecol Can 2019; 40:e323-e352. [PMID: 29680085 DOI: 10.1016/j.jogc.2018.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Liston R, Sawchuck D, Young D. N° 197c-Maintien des normes dans le cadre de la surveillance fœtale intrapartum et prénatale : amélioration de la qualité et gestion du risque. J Obstet Gynaecol Can 2019; 40:e359-e365. [PMID: 29680087 DOI: 10.1016/j.jogc.2018.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Filges I, Tercanli S, Hall JG. Fetal arthrogryposis: Challenges and perspectives for prenatal detection and management. Am J Med Genet C Semin Med Genet 2019; 181:327-336. [PMID: 31318155 DOI: 10.1002/ajmg.c.31723] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/23/2019] [Accepted: 06/27/2019] [Indexed: 12/28/2022]
Abstract
Antenatal identification of fetuses with multiple congenital contractures or arthrogryposis multiplex congenita (AMC) may be challenging. The first clinical sign is often reduced fetal movement and/or contractures, as seen on prenatal ultrasounds. This can be apparent at any point, from early to late pregnancy, may range from mild to severe involvement, with or without associated other structural anomalies. Possible etiologies and their prognosis need to be interpreted with respect to developmental timing. The etiology of AMC is highly heterogeneous and making the specific diagnosis will guide prognosis, counseling and prenatal and perinatal management. Current ultrasound practice identifies only approximately 25% of individuals with arthrogryposis prenatally before 24 weeks of pregnancy in a general obstetrics care population. There are currently no studies and guidelines that address the question of when and how to assess for fetal contractures and movements during pregnancy. The failure to identify fetuses with arthrogryposis before 24 weeks of pregnancy means that physicians and families are denied reproductive options and interventions that may improve outcome. We review current practice and recommend adjusting the current prenatal imaging and genetic diagnostic strategies to achieve early prenatal detection and etiologic diagnosis. We suggest exploring options for in utero therapy to increase fetal movement for ongoing pregnancies.
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Affiliation(s)
- Isabel Filges
- Medical Genetics, Institute of Medical Genetics and Pathology, University Hospital and University of Basel, Basel, Switzerland
| | - Sevgi Tercanli
- Center for Prenatal Ultrasound, Basel and University of Basel, Basel, Switzerland
| | - Judith G Hall
- Department of Medical Genetics and Pediatrics, University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
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Kantrowitz-Gordon I, Cunningham E, Reynolds N. Measurement of Maternal Mindful Awareness of Fetal Movement. J Midwifery Womens Health 2019; 64:604-612. [PMID: 31237110 DOI: 10.1111/jmwh.12981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 03/11/2019] [Accepted: 03/14/2019] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Decreased fetal movement is a common concern late in pregnancy that may be associated with increased fetal morbidity and mortality. Limited research suggests a relationship between maternal psychological factors and perception of fetal movement. The goal of this study was to test the reliability and external validity of a novel self-report instrument for maternal mindful awareness of fetal movement. METHODS Pregnant women who were at 20 weeks' gestation or later and feeling regular fetal movement (N = 497) were recruited online through a commercial pregnancy website to complete an internet survey from April to May 2016. The online survey included demographic and pregnancy characteristics, psychological and mindfulness measures, and investigator-developed items on mindful awareness of fetal movement. Reliability and validity of the instrument were tested with exploratory factor analysis, correlations with psychological variables, and hierarchical linear regression. RESULTS Exploratory factor analysis of mindful awareness of fetal movement items using principal components analysis showed a 2-factor structure, noticing and distracted, with internal consistency of α equal to .69 and .57, respectively. Hierarchical multiple regression analysis showed that noticing was associated with increased gestational age, mindfulness (observing facet), and maternal-fetal attachment. Distracted was associated with increased education level and prenatal anxiety and with decreased mindfulness (nonjudging facet). DISCUSSION There was moderate internal consistency in the items measuring mindful awareness of fetal movement. Findings suggest relationships between mindful awareness of fetal movement and state mindfulness, maternal-fetal attachment, and prenatal anxiety. More research is needed to further develop items for a mindful awareness of fetal movement scale suitable for research and clinical practice.
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Affiliation(s)
- Ira Kantrowitz-Gordon
- School of Nursing, University of Washington, Seattle, Washington.,Providence Medical Group, Everett, Washington
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Çizmecioğlu FM, Jones JH, Paterson WF, Kherra S, Kourime M, McGowan R, Shaikh MG, Donaldson M. Neonatal Features of the Prader-Willi Syndrome; The Case for Making the Diagnosis During the First Week of Life. J Clin Res Pediatr Endocrinol 2018; 10:264-273. [PMID: 29553044 PMCID: PMC6083474 DOI: 10.4274/jcrpe.0029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE Early diagnosis is of proven benefit in Prader-Willi syndrome (PWS). We therefore examined key perinatal features to aid early recognition. METHODS Data were collected from case records of subjects attending a multi-disciplinary clinic and from a retrospective birth questionnaire. RESULTS Ninety patients (54 male-36 female) were seen between 1991-2015, most with paternal deletion (n=56) or maternal isodisomy (n=26). Features included cryptorchidism in 94% males, preterm birth (26%), birthweight <2500 g (24%), polyhydramnios (23%), breech presentation (23%) and need for nasogastric feeding (83%). Reduced fetal movements (FM) were reported in 82.5% patients compared with 4% healthy siblings. Of 35 children born since 1999, 23 were diagnosed clinically within 28 days while diagnosis in 12 was >28 days: 1-12 months in seven; and 3.75-10.5 years in five. Typical PWS features in these 12 infants included hypotonia (100%), feeding difficulties (75%), cryptorchidism (83% males) and reduced FM (66%). Causes other than PWS including neuromuscular disease were considered in nine patients. CONCLUSION Neonatal hypotonia, reduced FM, feeding difficulties and cryptorchidism should immediately suggest PWS, yet late diagnosis continues in some cases. Awareness of the typical features of PWS in newborn units is required to allow prompt detection even in the presence of confounding factors such as prematurity.
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Affiliation(s)
- Filiz Mine Çizmecioğlu
- Kocaeli University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Kocaeli, Turkey,* Address for Correspondence: Kocaeli University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Kocaeli, Turkey E-mail:
| | - Jeremy Huw Jones
- Royal Hospital for Children, Clinic of Endocrinology, Glasgow, United Kingdom
| | | | | | - Mariam Kourime
- University Hospital Abderrahim Harouchi, Casablanca, Morocco
| | - Ruth McGowan
- Southern Glasgow University Hospital, West of Scotland Genetic Services, Glasgow, United Kingdom
| | - M. Guftar Shaikh
- Royal Hospital for Children, Clinic of Endocrinology, Glasgow, United Kingdom
| | - Malcolm Donaldson
- University of Glasgow Faculty of Medicine, Royal Hospital for Children, Clinic of Child Health, Glasgow, United Kingdom
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Heazell AEP, Budd J, Li M, Cronin R, Bradford B, McCowan LME, Mitchell EA, Stacey T, Martin B, Roberts D, Thompson JMD. Alterations in maternally perceived fetal movement and their association with late stillbirth: findings from the Midland and North of England stillbirth case-control study. BMJ Open 2018; 8:e020031. [PMID: 29982198 PMCID: PMC6042603 DOI: 10.1136/bmjopen-2017-020031] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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.
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Affiliation(s)
- Alexander E P Heazell
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biological, Medical and Human Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Jayne Budd
- Manchester Academic Health Science Centre, St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Minglan Li
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Robin Cronin
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Billie Bradford
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | | | - Edwin A Mitchell
- Department of Paediatrics, Child Health and Youth Health, University of Auckland, Auckland, New Zealand
| | | | - Bill Martin
- Department of Obstetrics, Birmingham Women's Hospital NHS Foundation Trust, Birmingham, UK
| | - Devender Roberts
- Department of Obstetrics, Liverpool Women's NHS Foundation Trust, Liverpool, Liverpool, UK
- Department of Obstetrics and Gynaecology, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - John M D Thompson
- Department of Paediatrics, Child Health and Youth Health, University of Auckland, Auckland, New Zealand
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Güney E, Uçar T. Effect of the fetal movement count on maternal-fetal attachment. Jpn J Nurs Sci 2018; 16:71-79. [PMID: 29774647 DOI: 10.1111/jjns.12214] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 03/10/2018] [Accepted: 03/13/2018] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Esra Güney
- Department of Midwifery, İnönü University, Malatya, Turkey
| | - Tuba Uçar
- Department of Midwifery, İnönü University, Malatya, Turkey
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Avci R, Wilson JD, Escalona-Vargas D, Eswaran H. Tracking Fetal Movement Through Source Localization From Multisensor Magnetocardiographic Recordings. IEEE J Biomed Health Inform 2018; 22:758-765. [PMID: 28391212 PMCID: PMC5975641 DOI: 10.1109/jbhi.2017.2690879] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Due to its high spatial and temporal resolution, fetal magnetocardiography (fMCG) measurements have been used for fetal movement (FM) detection in several studies, which considered the changes in the amplitude and/or morphology of measured fMCG signals. Using source localization for fMCG measurements, we propose a novel method to fit a magnetic dipole moment to fetal heart signals and investigate the positional changes of magnetic dipole in order to detect FMs. We first split each fMCG recording into 6-s time windows. Then, the magnetic dipole location and orientation for each time window are estimated using our inverse solution model. Finally, the distance between magnetic dipole positions in adjacent time windows is computed. Also, we calculate the dot products of the normalized magnetic dipoles to monitor the orientational changes. We analyzed 28 fMCG measurements from 23 subjects to investigate accuracy of the dipole fitting results. For each dipole fit, our model described the measured data with a goodness-of-fit value over 97% and with a fitting error of less than 2%. We observed that magnetic dipole positions significantly moved for some time windows. The time points at which the significant movement was observed were correlated with the heart rate acceleration as well. In addition to identifying the time points of the movement, our method is capable of observing rotational movement checking orientation of the dipoles.
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Li M, Thompson JMD, Cronin RS, Gordon A, Raynes-Greenow C, Heazell AEP, Stacey T, Culling V, Bowring V, Mitchell EA, McCowan LME, Askie L. The Collaborative IPD of Sleep and Stillbirth (Cribss): is maternal going-to-sleep position a risk factor for late stillbirth and does maternal sleep position interact with fetal vulnerability? An individual participant data meta-analysis study protocol. BMJ Open 2018; 8:e020323. [PMID: 29643161 PMCID: PMC5898330 DOI: 10.1136/bmjopen-2017-020323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Accumulating evidence has shown an association between maternal supine going-to-sleep position and stillbirth in late pregnancy. Advising women not to go-to-sleep on their back can potentially reduce late stillbirth rate by 9%. However, the association between maternal right-sided going-to-sleep position and stillbirth is inconsistent across studies. Furthermore, individual studies are underpowered to investigate interactions between maternal going-to-sleep position and fetal vulnerability, which is potentially important for producing clear and tailored public health messages on safe going-to-sleep position. We will use individual participant data (IPD) from existing studies to assess whether right-side and supine going-to-sleep positions are independent risk factors for late stillbirth and to test the interaction between going-to-sleep position and fetal vulnerability. METHODS AND ANALYSIS An IPD meta-analysis approach will be used using the Cochrane Collaboration-endorsed methodology. We will identify case-control and prospective cohort studies and randomised trials which collected maternal going-to-sleep position data and pregnancy outcome data that included stillbirth. The primary outcome is stillbirth. A one stage procedure meta-analysis, stratified by study with adjustment of a priori confounders will be carried out. ETHICS AND DISSEMINATION The IPD meta-analysis has obtained central ethics approval from the New Zealand Health and Disability Ethics Committee, ref: NTX/06/05/054/AM06. Individual studies should also have ethical approval from relevant local ethics committees. Interpretation of the results will be discussed with consumer representatives. Results of the study will be published in peer-reviewed journals and presented at international conferences. PROSPERO REGISTRATION NUMBER CRD42017047703.
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Affiliation(s)
- Minglan Li
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - John M D Thompson
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
- Department of Paediatrics and Child Health, University of Auckland, Auckland, New Zealand
| | - Robin S Cronin
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Adrienne Gordon
- Department of Newborn Care, Royal Prince Alfred Hospital Women and Babies, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Camille Raynes-Greenow
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Alexander E P Heazell
- Division of Developmental Biomedicine, Faculty of Medical and Human Sciences, Maternal and Fetal Health Research Centre, University of Manchester, Manchester, UK
- St. Mary’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | | | | | - Edwin A Mitchell
- Department of Paediatrics and Child Health, University of Auckland, Auckland, New Zealand
| | - Lesley M E McCowan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Lisa Askie
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
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Voegtline KM, Costigan KA, DiPietro JA. Maternal salivary testosterone in pregnancy and fetal neuromaturation. Dev Psychobiol 2017; 59:822-831. [PMID: 28888054 DOI: 10.1002/dev.21550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 06/28/2017] [Indexed: 11/07/2022]
Abstract
Testosterone exposure during pregnancy has been hypothesized as a mechanism for sex differences in brain and behavioral development observed in the postnatal period. The current study documents the natural history of maternal salivary testosterone from 18 weeks gestation of pregnancy to 6 months postpartum, and investigates associations with fetal heart rate, motor activity, and their integration. Findings indicate maternal salivary testosterone increases with advancing gestation though no differences by fetal sex were detected. High intra-individual stability in prenatal testosterone levels extend into the postnatal period, particularly for pregnancies with male fetuses. With respect to fetal development, by 36 weeks gestation higher maternal prenatal salivary testosterone was significantly associated with faster fetal heart rate and less optimal somatic-cardiac integration. Measurement of testosterone in saliva is a useful tool for repeated-measures studies of hormonal concomitants of pregnancy. Moreover, higher maternal testosterone levels are associated with modest interference to fetal neurobehavioral development.
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Affiliation(s)
- Kristin M Voegtline
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Kathleen A Costigan
- Maternal-Fetal Medicine Division, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Janet A DiPietro
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Sajapala S, AboEllail MAM, Kanenishi K, Mori N, Marumo G, Hata T. 4D ultrasound study of fetal movement early in the second trimester of pregnancy. J Perinat Med 2017; 45:737-743. [PMID: 28708574 DOI: 10.1515/jpm-2016-0250] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 01/30/2017] [Indexed: 11/15/2022]
Abstract
AIM To assess the frequency of fetal movement and reproducibility of fetal movement counting in normal singleton pregnancies early in the second trimester using four-dimensional (4D) ultrasound. METHODS Twenty-nine singleton pregnancies were studied for 15 min employing 4D ultrasound at 14-16 (19 cases) and 17-19 (10 cases) weeks of gestation. The frequencies of eight fetal movements (head anteflexion, head retroflexion, body rotation, hand to face movement, general movement, isolated arm movement, isolated leg movement and mouthing movement) were evaluated. RESULTS The most frequent fetal movements were isolated arm movements at 14-16 and 17-19 weeks' gestation. There was a significant difference only in the frequency of mouthing movement between 14-16 and 17-19 weeks' gestation (P<0.05). All fetal movements showed intra- and inter-class correlation coefficients greater than 0.87, with good intra- and inter-observer agreements. CONCLUSION The difference in the frequency of mouthing movement at 14-16 and 17-19 weeks' gestation may be due to increasing fetal swallowing because of the increasing amniotic fluid early in the second trimester of pregnancy. To the best of our knowledge, this is the first study on the reproducibility assessment of fetal movement counting using 4D ultrasound. However, the data and their interpretation in the present study should be taken with some degree of caution because of the small number of subjects studied. Further studies involving a larger sample size are needed to assess the reproducibility of fetal movement counting using 4D ultrasound.
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Pirhadi M, Valiani M. Assessing effects of BL67 points stimulation on fetal heart rate parameters and fetal movements during nonstress test. J Educ Health Promot 2017; 6:43. [PMID: 28616410 PMCID: PMC5470304 DOI: 10.4103/jehp.jehp_120_15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CONTEXT One of the main goals of antenatal testing is to identify fetuses at the risk of neurologic injury or death so that these adverse outcomes can be prevented. We want to assess the effects of BL67 points' stimulation on fetal heart rate parameters and fetal movements during nonstress test (NST). We did a quasi-experimental design in Shahid Beheshti Hospital in Isfahan in 2011. AIMS This study aims to assessment of the effects of BL67 points' stimulation on fetal heart rate parameters and fetal movements. SETTINGS AND DESIGN We did a randomized controlled clinical trial in Shahid Beheshti Hospital in Isfahan in 2011. SUBJECTS AND METHODS This study is a quasi-experimental design that was conducted in one group and the two steps (before-after study). Participants were pregnant women (primigravida) who were 35-18 years that refer to Shahid Beheshti Hospital in Isfahan in 2011 to receive routine prenatal care. The 32 pregnant women were selected for acupressure during the second NST. STATISTICAL ANALYSIS USED The statistical processing was performed by descriptive, paired t-test through SPSS version 20. RESULTS There was no significant difference in mean number of accelerations in fetal heart rate and mean number of fetal movement before and after intervention; however, there was a significant difference in mean time to the second acceleration before and after the intervention (P = 0.04). CONCLUSIONS No difference between parameters of the fetal heart rate before and after stimulation and lack of uterine response by this method is a significant advantage and is probably why stimulating this point could not create a risk to the fetuses.
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Affiliation(s)
- Masume Pirhadi
- Department of Midwifery and Reproductive Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahboube Valiani
- Department of Midwifery and Reproductive Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Jansson LM, Velez M, McConnell K, Spencer N, Tuten M, Jones HE, King VL, Gandotra N, Milio LA, Voegtline K, DiPietro JA. Maternal buprenorphine treatment and fetal neurobehavioral development. Am J Obstet Gynecol 2017; 216:529.e1-529.e8. [PMID: 28188773 DOI: 10.1016/j.ajog.2017.01.040] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/04/2016] [Accepted: 01/31/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Gestational opioid use/misuse is escalating in the United States; however, little is understood about the fetal effects of medications used to treat maternal opioid use disorders. OBJECTIVE The purpose of this study was to determine the effect of maternal buprenorphine administration on longitudinal fetal neurobehavioral development. STUDY DESIGN Forty-nine buprenorphine-maintained women who attended a substance use disorder treatment facility with generally uncomplicated pregnancies underwent fetal monitoring for 60 minutes at times of trough and peak maternal buprenorphine levels. Data were collected at 24, 28, 32, and 36 weeks gestation. Fetal neurobehavioral indicators (ie, heart rate, motor activity, and their integration [fetal movement-fetal heart rate coupling]) were collected via an actocardiograph, digitized and quantified. Longitudinal data analysis relied on hierarchic linear modeling. RESULTS Fetal heart rate, heart rate variability, and heart rate accelerations were significantly reduced at peak vs trough maternal buprenorphine levels. Effects were significant either by or after 28 weeks gestation and tended to intensify with advancing gestation. Fetal motor activity and fetal movement-fetal heart rate coupling were depressed from peak to trough at 36 weeks gestation. Polysubstance exposure did not significantly affect fetal neurobehavioral parameters, with the exception that fetuses of heavier smokers moved significantly less than those of lighter smokers at 36 weeks gestation. By the end of gestation, higher maternal buprenorphine dose was related to depression of baseline fetal cardiac measures at trough. CONCLUSION Maternal buprenorphine administration has acute suppressive effects on fetal heart rate and movement, and the magnitude of these effects increases as gestation progresses. Higher dose (≥13 mg) appears to exert greater depressive effects on measures of fetal heart rate and variability. These findings should be balanced against comparisons to gestational methadone effects, relatively good outcomes of buprenorphine-exposed infants, and recognition of the benefits of medication-assisted treatment for pregnant women with opioid use disorders in optimizing pregnancy outcomes.
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Affiliation(s)
- Lauren M Jansson
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Martha Velez
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Krystle McConnell
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nancy Spencer
- Johns Hopkins Bayview Hospital, Department of Nursing, Baltimore, MD
| | - Michelle Tuten
- University of Maryland School of Social Work, Baltimore, MD
| | - Hendree E Jones
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD; University of North Carolina Chapel Hill, Department of Obstetrics and Gynecology
| | - Van L King
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Neeraj Gandotra
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lorraine A Milio
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kristin Voegtline
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
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Linde A, Pettersson K, Rådestad I. Women's Experiences of Fetal Movements before the Confirmation of Fetal Death--Contractions Misinterpreted as Fetal Movement. Birth 2015; 42:189-94. [PMID: 25703963 DOI: 10.1111/birt.12151] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Decreased fetal movement often precedes a stillbirth. The objective of this study was to describe women's experiences of fetal movement before the confirmation of fetal death. METHODS Data were collected through a Web-based questionnaire. Women with stillbirths after 28 gestational weeks were self-recruited. Content analysis was used to analyze the answers to one open question. The statements from mothers of a stillborn, born during gestational weeks 28 to 36 were compared with those of a stillborn at term. RESULTS The women's 215 answers were divided into three categories: decreased, weak, and no fetal movement at all; 154 (72%) of the descriptions were divided into three subcategories: decreased and weak movement (106; 49%), no movement at all (35; 16%), and contraction interpreted as movement (13; 6%). The category fetal movement as normal includes 39 (18%) of the descriptions. The third category, extremely vigorous fetal activity followed by no movement at all, includes 22 (10%) of the descriptions. Eight (15%) of the women with stillbirths in gestational weeks 28 to 36 interpreted contractions as fetal movement as compared to 5 (5%) of the women with stillbirths at term. DISCUSSION Uterine contractions can be interpreted as fetal movement. A single episode of extremely vigorous fetal activity can precede fetal death. The majority of the women experienced decreased, weaker, or no fetal movement at all 2 days before fetal death was diagnosed. Mothers should be educated to promptly report changes in fetal movement to their health care providers. Using fetal movement information to evaluate possible fetal distress may lead to reductions in stillbirths.
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Affiliation(s)
- Anders Linde
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Sophiahemmet University, Stockholm, Sweden
| | - Karin Pettersson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Abstract
In order to assign appropriate baseline estimation algorithms to different fetal heart rate tracing, a method to evaluate the fetal heart rate (FHR) baseline combining with the fetal movement information was proposed. Fetal actography and tocography were used to extract the fetal movement information. The results showed that the combined method, where the fetal movement detection result was the union of results of actography and tocography, achieved a better performance with the highest sensitivity and an acceptable positive predictive value (PPV). Furthermore, the mean absolute errors (MAEs) of basal FHR values between the two algorithms and the expert were calculated with respect to the duration coefficient of fetal movement. The results showed that the algorithm using empirical mode decomposition (EMD) and Kohonen neural network (KNN) had lower MAEs than a traditional linear baseline estimation algorithm as the duration coefficient increased. However, if the duration coefficient is below 0.2, the errors may be tolerant for the FHR baseline estimation by a linear baseline estimation algorithm, which indicates that different algorithms may be selected for FHR baseline estimation based on different duration coefficients of fetal movement.
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Affiliation(s)
- Yaosheng Lu
- Department of Electronic Engineering, Jinan University, Guangzhou 510632, China
| | - Xiaodong Li
- Department of Electronic Engineering, Jinan University, Guangzhou 510632, China
| | - Shouyi Wei
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, USA
| | - Xiaolei Liu
- Department of Electrical and Electronic Engineering, University of Hong Kong, Hong Kong, China
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Røislien J, Winje B. Feature extraction across individual time series observations with spikes using wavelet principal component analysis. Stat Med 2013; 32:3660-9. [PMID: 23553851 DOI: 10.1002/sim.5797] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 01/15/2013] [Accepted: 02/26/2013] [Indexed: 11/08/2022]
Abstract
Clinical studies frequently include repeated measurements of individuals, often for long periods. We present a methodology for extracting common temporal features across a set of individual time series observations. In particular, the methodology explores extreme observations within the time series, such as spikes, as a possible common temporal phenomenon. Wavelet basis functions are attractive in this sense, as they are localized in both time and frequency domains simultaneously, allowing for localized feature extraction from a time-varying signal. We apply wavelet basis function decomposition of individual time series, with corresponding wavelet shrinkage to remove noise. We then extract common temporal features using linear principal component analysis on the wavelet coefficients, before inverse transformation back to the time domain for clinical interpretation. We demonstrate the methodology on a subset of a large fetal activity study aiming to identify temporal patterns in fetal movement (FM) count data in order to explore formal FM counting as a screening tool for identifying fetal compromise and thus preventing adverse birth outcomes.
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Affiliation(s)
- Jo Røislien
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
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Raynes-Greenow CH, Gordon A, Li Q, Hyett JA. A cross-sectional study of maternal perception of fetal movements and antenatal advice in a general pregnant population, using a qualitative framework. BMC Pregnancy Childbirth 2013; 13:32. [PMID: 23383737 PMCID: PMC3572429 DOI: 10.1186/1471-2393-13-32] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 01/24/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Maternal perception of fetal movements has been used as a measure of fetal well-being. Yet a Cochrane review does not recommend formal fetal movement counting compared to discretional fetal movement counting. There is some evidence that suggests that the quality of fetal movements can precede quantitative changes however there has been almost no assessment of how women describe movements and whether these descriptions may be useful in a clinical setting. Therefore we aimed to examine maternal perception of fetal movements using a qualitative framework. METHODS Using a cross-sectional design we identified women during routine antenatal care at a tertiary referral hospital, in Sydney, Australia. Eligible women were pregnant ≥ 28 weeks, carrying a single child, > 18 years old, and with sufficient English literacy to self-complete a questionnaire. Post-natally the medical records were reviewed and demographic, pregnancy and fetal outcome data were extracted. Text responses to questions regarding maternal descriptions of fetal movements throughout pregnancy, were analysed using thematic analysis in an explicit process. RESULTS 156 women participated. There was a general pattern to fetal movement descriptions with increasing gestation, beginning with words such as "gentle", to descriptions of "strong" and "limb" movements, and finally to "whole body" movements. Women perceived and described qualitative changes to fetal movements that changed throughout gestation. The majority (83%) reported that they were asked to assess fetal movements in an implicit qualitative method during their antenatal care. In contrast, only 16% regularly counted fetal movements and many described counting as confusing and reported that the advice they had received on counting differed. CONCLUSIONS This is the first study to use qualitative analysis to identify that pregnant women perceive fetal movements and can describe them in a relatively homogenous way throughout pregnancy that follow a general pattern of fetal growth and development. These findings suggest that women's perception of fetal wellbeing based on their own assessment of fetal movement is used in an ad hoc method in antenatal care by clinicians.
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Affiliation(s)
| | - Adrienne Gordon
- Department of Neonatal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, NSW, Australia
| | - Qiushuang Li
- Sydney School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Jon A Hyett
- Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, NSW, Australia
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Grant-Beuttler M, Glynn LM, Salisbury AL, Davis EP, Holliday C, Sandman CA. Development of Fetal Movement between 26 and 36-Weeks' Gestation in Response to Vibro-Acoustic Stimulation. Front Psychol 2011; 2:350. [PMID: 22207855 PMCID: PMC3245669 DOI: 10.3389/fpsyg.2011.00350] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 11/08/2011] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Ultrasound observation of fetal movement has documented general trends in motor development and fetal age when motor response to stimulation is observed. Evaluation of fetal movement quality, in addition to specific motor activity, may improve documentation of motor development and highlight specific motor responses to stimulation. AIM The aim of this investigation was to assess fetal movement at 26 and 36-weeks gestation during three conditions (baseline, immediate response to vibro-acoustic stimulation (VAS), and post-response). DESIGN A prospective, longitudinal design was utilized. SUBJECTS Twelve normally developing fetuses, eight females and four males, were examined with continuous ultrasound imaging. OUTCOME MEASURES The fetal neurobehavioral coding system (FENS) was used to evaluate the quality of motor activity during 10-s epochs over the three conditions. RESULTS Seventy-five percent of the fetuses at the 26-week assessment and 100% of the fetuses at the 36-week assessment responded with movement immediately following stimulation. Significant differences in head, fetal breathing, general, limb, and mouthing movements were detected between the 26 and 36-week assessments. Movement differences between conditions were detected in head, fetal breathing, limb, and mouthing movements. CONCLUSION Smoother and more complex movement was observed with fetal maturation. Following VAS stimulation, an immediate increase of large, jerky movements suggests instability in fetal capabilities. Fetal movement quality changes over gestation may reflect sensorimotor synaptogenesis in the central nervous system, while observation of immature movement patterns following VAS stimulation may reflect movement pattern instability.
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Affiliation(s)
- Marybeth Grant-Beuttler
- Department of Physical Therapy, Crean School of Health and Life Sciences, Schmid College of Science and Technology, Chapman University Orange, CA, USA
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Araki M, Nishitani S, Ushimaru K, Masuzaki H, Oishi K, Shinohara K. Fetal response to induced maternal emotions. J Physiol Sci 2010; 60:213-20. [PMID: 20169432 PMCID: PMC10717758 DOI: 10.1007/s12576-010-0087-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Accepted: 01/21/2010] [Indexed: 10/19/2022]
Abstract
This study investigated the relationship between fetal movements and acute maternal emotional changes during pregnancy. Two empirically validated feature film clips were used for the external generation of two subjectively and facially well-characterized target emotions: happiness and sadness. We simultaneously monitored separate fetal arm, leg, and trunk movements by means of two ultrasound apparatuses while maternal emotions were manipulated by film clip presentation. The number of fetal arm movements, but not the duration, was increased when pregnant women were being shown a happy film. Both the number and the duration of fetal arm movements decreased with the sad film presentation. Neither the presentation of happiness nor the presentation of sadness affected fetal leg or trunk movements. These findings suggest that induced emotions in pregnant women primarily affect arm movements of their fetuses, and that positive and negative emotions have the opposite effects on fetus movement.
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Affiliation(s)
- Miyuki Araki
- Department of Neurobiology and Behavior, Unit of Basic Medical Sciences, Course of Medical and Dental Sciences, Nagasaki University, Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523 Japan
- Department of Nursing, Health Sciences, Nagasaki University, Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8520 Japan
| | - Shota Nishitani
- Department of Neurobiology and Behavior, Unit of Basic Medical Sciences, Course of Medical and Dental Sciences, Nagasaki University, Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523 Japan
| | - Keisho Ushimaru
- Obstetrics and Gynecology, Garden Hills Women’s Clinic, Ozasa, 5-15-21, Chuo Ward, Ozasa, Fukuoka, 810-0033 Japan
| | - Hideaki Masuzaki
- Department of Obstetrics and Gynecology, School of Medicine, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan
| | - Kazuyo Oishi
- Department of Nursing, Health Sciences, Nagasaki University, Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8520 Japan
| | - Kazuyuki Shinohara
- Department of Neurobiology and Behavior, Unit of Basic Medical Sciences, Course of Medical and Dental Sciences, Nagasaki University, Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523 Japan
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Abstract
Although postnatal psychologic distress has been widely studied for many years, particularly with a focus on postpartum depression, symptoms of maternal depression, stress, and anxiety are not more common or severe after childbirth than during pregnancy. This paper reviews the newer body of research aimed at identifying the effects of women's antenatal psychologic distress on fetal behavior and child development, and the biologic pathways for this influence. These studies are in line with the growing body of literature supporting the "fetal origins hypothesis" that prenatal environmental exposures--including maternal psychologic state-based alterations in in utero physiology--can have sustained effects across the lifespan.
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Affiliation(s)
- Michael T. Kinsella
- Behavioral Medicine Program, Department of Psychiatry, Columbia University Medical Center
| | - Catherine Monk
- Behavioral Medicine Program, Department of Psychiatry, Columbia University Medical Center
- New York State Psychiatric Institute
- Department of Obstetrics & Gynecology, Columbia University Medical Center
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Swanson RW. Maternal Counting of Fetal Movements. Part II: Case Presentations. Can Fam Physician 1988; 34:567-569. [PMID: 21253143 PMCID: PMC2219039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The use of daily maternal counting of fetal movements as an antenatal screening test is illustrated in three case studies. The cases described carry both high and low risks, and illustrate the technique of counting fetal movements. The author suggests that performing this antenatal screening test on all patients may reduce perinatal mortality.
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Swanson RW. Daily maternal counting of fetal movement as an antenatal screening test. Part I. A review. Can Fam Physician 1988; 34:561-565. [PMID: 21253142 PMCID: PMC2219054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The author reviews use of maternal counting of fetal movements as an antenatal screening test. This test appears to be a sensitive indicator of fetal well-being and a useful method for preventing inexplicable stillbirths. Evidence suggests that it should be considered a routine antenatal screening test for all pregnant women, and not just for those at high risk for perinatal morbidity and mortality. Screening should begin at 28 weeks gestation.
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