St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, M13 9WL, Manchester, UK.
Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
BMC Pregnancy Childbirth. 2017 Nov 13;17(1):369. doi: 10.1186/s12884-017-1555-6.
Stillbirth after 28 weeks gestation affects between 1.3-8.8 per 1000 births in high-income countries. The majority of stillbirths in this setting occur in women without established risk factors. Identification of risk factors which could be identified and managed in pregnancy is a priority in stillbirth prevention research. This study aimed to evaluate women's experiences of fetal movements and how these relate to stillbirth.
An international internet-based case-control study of women who had a stillbirth ≥28 weeks' gestation within 30 days prior to completing the survey (n = 153) and women with an ongoing pregnancy or a live born child (n = 480). The online questionnaire was developed with parent stakeholder organizations using a mixture of categorical and open-ended responses and Likert scales. Univariate and multiple logistic regression was used to determine crude (unadjusted) and adjusted odds ratios (aOR) with 95% confidence intervals (CI). Summative content analysis was used to analyse free text responses.
Women whose pregnancy ended in stillbirth were less likely to check fetal movements (aOR 0.54, 95% CI 0.35-0.83) and were less likely to be told to do so by a health professional (aOR 0.55, 95% CI 0.36-0.86). Pregnancies ending in stillbirth were more frequently associated with significant abnormalities in fetal movements in the preceding two weeks; this included a significant reduction in fetal activity (aOR 14.1, 95% CI 7.27-27.45) or sudden single episode of excessive fetal activity (aOR 4.30, 95% CI 2.25-8.24). Cases described their perception of changes in fetal activity differently to healthy controls e.g. vigorous activity was described as "frantic", "wild" or "crazy" compared to "powerful" or "strong".
Alterations in fetal activity are associated with increased risk of stillbirth. Pregnant women should be educated about awareness of fetal activity and reporting abnormal activity to health professionals.
在高收入国家，28 周以上妊娠的死胎发生率为每 1000 例活产 1.3-8.8 例。在这种情况下，大多数死胎发生在没有明确危险因素的女性中。确定可在妊娠期间识别和管理的危险因素是预防死产研究的重点。本研究旨在评估女性的胎儿运动体验，以及这些体验与死产的关系。
一项针对在完成调查前 30 天内发生≥28 周妊娠死胎的女性（n=153）和正在妊娠或分娩活产儿的女性（n=480）的国际互联网病例对照研究。该在线问卷由家长利益相关者组织使用分类和开放式回答以及李克特量表共同制定。采用单变量和多变量逻辑回归分析确定粗（未调整）和调整优势比（aOR）及其 95%置信区间（CI）。总结性内容分析用于分析自由文本回复。
妊娠结局为死胎的女性较少检查胎儿运动（aOR 0.54，95%CI 0.35-0.83），且较少被医疗保健专业人员告知进行检查（aOR 0.55，95%CI 0.36-0.86）。在过去两周内，与胎儿运动显著异常相关的死胎妊娠更为常见；这包括胎儿活动显著减少（aOR 14.1，95%CI 7.27-27.45）或突然出现单次过度胎儿活动（aOR 4.30，95%CI 2.25-8.24）。病例组与健康对照组对胎儿活动变化的描述不同，例如，与“有力”或“强壮”相比，剧烈活动被描述为“疯狂”、“狂野”或“疯狂”。
胎儿活动的改变与死产风险增加有关。应教育孕妇了解胎儿活动并向医疗保健专业人员报告异常活动。
