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Reduction of late stillbirth with the introduction of fetal movement information and guidelines - a clinical quality improvement.

Tveit JV, Saastad E, Stray-Pedersen B, Børdahl PE, Flenady V, Fretts R, Frøen JF - BMC Pregnancy Childbirth (2009)

Bottom Line: We found that information to women and management of DFM varied significantly between hospitals.Reports of DFM did not increase during the intervention.The use of ultrasound in management increased, while additional follow up visits and admissions for induction were reduced.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Obstetrics and Gynecology, and Centre for Perinatal Research, Rikshospitalet University Hospital, University of Oslo, Medical Faculty, Norway. julievh@medisin.uio.no

ABSTRACT

Background: Women experiencing decreased fetal movements (DFM) are at increased risk of adverse outcomes, including stillbirth. Fourteen delivery units in Norway registered all cases of DFM in a population-based quality assessment. We found that information to women and management of DFM varied significantly between hospitals. We intended to examine two cohorts of women with DFM before and during two consensus-based interventions aiming to improve care through: 1) written information to women about fetal activity and DFM, including an invitation to monitor fetal movements, 2) guidelines for management of DFM for health-care professionals.

Methods: All singleton third trimester pregnancies presenting with a perception of DFM were registered, and outcomes collected independently at all 14 hospitals. The quality assessment period included April 2005 through October 2005, and the two interventions were implemented from November 2005 through March 2007. The baseline versus intervention cohorts included: 19,407 versus 46,143 births and 1215 versus 3038 women with DFM, respectively.

Results: Reports of DFM did not increase during the intervention. The stillbirth rate among women with DFM fell during the intervention: 4.2% vs. 2.4%, (OR 0.51 95% CI 0.32-0.81), and 3.0/1000 versus 2.0/1000 in the overall study population (OR 0.67 95% CI 0.48-0.93). There was no increase in the rates of preterm births, fetal growth restriction, transfers to neonatal care or severe neonatal depression among women with DFM during the intervention. The use of ultrasound in management increased, while additional follow up visits and admissions for induction were reduced.

Conclusion: Improved management of DFM and uniform information to women is associated with fewer stillbirths.

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Related in: MedlinePlus

Stillbirth rates in pregnancies presenting decreased fetal movements. Statistical process control chart presenting the monthly stillbirth rates and means during the baseline quality assessment period and the intervention period. The arrow indicates the time (seventh month of intervention) at which a significant change was documented during the intervention.
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Figure 2: Stillbirth rates in pregnancies presenting decreased fetal movements. Statistical process control chart presenting the monthly stillbirth rates and means during the baseline quality assessment period and the intervention period. The arrow indicates the time (seventh month of intervention) at which a significant change was documented during the intervention.

Mentions: The stillbirth rates among women with DFM were reduced by almost 50% (OR 0.51; 95% CI 0.32–0.81, p = 0.004)) from 4.2% (n = 50) to 2.4% (n = 73) during the intervention. Stillbirth rates among women in the entire cohort were reduced by one third from 3.0/1000 to 2.0/1000 (OR 0.67; 95% CI 0.48–0.93, p = 0.02). Independent data from the Medical Birth Registry in Norway, confirmed that the stillbirth rate in our total cohort of births was comparable to the rest of Norway in the baseline observation (OR 1.06; 95% CI 0.70–1.65, p = 0.73), and significantly lower during the intervention period (OR 0.64; 95% CI 0.47–0.87, p = 0.005). The intervention was followed prospectively with statistical process control charts which indicated a significant change in mortality after 7 months of intervention (arrow in figure 2), and no month during the intervention with a mortality exceeding the pre-intervention mean (figure 2). There was no increase in secondary outcomes such as preterm births, FGR, severe neonatal depression or transfers to neonatal care among women with DFM during the intervention period (table 1).


Reduction of late stillbirth with the introduction of fetal movement information and guidelines - a clinical quality improvement.

Tveit JV, Saastad E, Stray-Pedersen B, Børdahl PE, Flenady V, Fretts R, Frøen JF - BMC Pregnancy Childbirth (2009)

Stillbirth rates in pregnancies presenting decreased fetal movements. Statistical process control chart presenting the monthly stillbirth rates and means during the baseline quality assessment period and the intervention period. The arrow indicates the time (seventh month of intervention) at which a significant change was documented during the intervention.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2734741&req=5

Figure 2: Stillbirth rates in pregnancies presenting decreased fetal movements. Statistical process control chart presenting the monthly stillbirth rates and means during the baseline quality assessment period and the intervention period. The arrow indicates the time (seventh month of intervention) at which a significant change was documented during the intervention.
Mentions: The stillbirth rates among women with DFM were reduced by almost 50% (OR 0.51; 95% CI 0.32–0.81, p = 0.004)) from 4.2% (n = 50) to 2.4% (n = 73) during the intervention. Stillbirth rates among women in the entire cohort were reduced by one third from 3.0/1000 to 2.0/1000 (OR 0.67; 95% CI 0.48–0.93, p = 0.02). Independent data from the Medical Birth Registry in Norway, confirmed that the stillbirth rate in our total cohort of births was comparable to the rest of Norway in the baseline observation (OR 1.06; 95% CI 0.70–1.65, p = 0.73), and significantly lower during the intervention period (OR 0.64; 95% CI 0.47–0.87, p = 0.005). The intervention was followed prospectively with statistical process control charts which indicated a significant change in mortality after 7 months of intervention (arrow in figure 2), and no month during the intervention with a mortality exceeding the pre-intervention mean (figure 2). There was no increase in secondary outcomes such as preterm births, FGR, severe neonatal depression or transfers to neonatal care among women with DFM during the intervention period (table 1).

Bottom Line: We found that information to women and management of DFM varied significantly between hospitals.Reports of DFM did not increase during the intervention.The use of ultrasound in management increased, while additional follow up visits and admissions for induction were reduced.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Obstetrics and Gynecology, and Centre for Perinatal Research, Rikshospitalet University Hospital, University of Oslo, Medical Faculty, Norway. julievh@medisin.uio.no

ABSTRACT

Background: Women experiencing decreased fetal movements (DFM) are at increased risk of adverse outcomes, including stillbirth. Fourteen delivery units in Norway registered all cases of DFM in a population-based quality assessment. We found that information to women and management of DFM varied significantly between hospitals. We intended to examine two cohorts of women with DFM before and during two consensus-based interventions aiming to improve care through: 1) written information to women about fetal activity and DFM, including an invitation to monitor fetal movements, 2) guidelines for management of DFM for health-care professionals.

Methods: All singleton third trimester pregnancies presenting with a perception of DFM were registered, and outcomes collected independently at all 14 hospitals. The quality assessment period included April 2005 through October 2005, and the two interventions were implemented from November 2005 through March 2007. The baseline versus intervention cohorts included: 19,407 versus 46,143 births and 1215 versus 3038 women with DFM, respectively.

Results: Reports of DFM did not increase during the intervention. The stillbirth rate among women with DFM fell during the intervention: 4.2% vs. 2.4%, (OR 0.51 95% CI 0.32-0.81), and 3.0/1000 versus 2.0/1000 in the overall study population (OR 0.67 95% CI 0.48-0.93). There was no increase in the rates of preterm births, fetal growth restriction, transfers to neonatal care or severe neonatal depression among women with DFM during the intervention. The use of ultrasound in management increased, while additional follow up visits and admissions for induction were reduced.

Conclusion: Improved management of DFM and uniform information to women is associated with fewer stillbirths.

Show MeSH
Related in: MedlinePlus