母亲感知到的胎动变化及其与晚期死产的关联：英格兰中部和北部死产病例对照研究的结果
Alterations in maternally perceived fetal movement and their association with late stillbirth: findings from the Midland and North of England stillbirth case-control study.
作者信息
Heazell Alexander E P, Budd Jayne, Li Minglan, Cronin Robin, Bradford Billie, McCowan Lesley M E, Mitchell Edwin A, Stacey Tomasina, Martin Bill, Roberts Devender, Thompson John M D
机构信息
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.
出版信息
BMJ Open. 2018 Jul 6;8(7):e020031. doi: 10.1136/bmjopen-2017-020031.
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.
目的
报告死产女性与相似孕周活产对照者对胎动的感知情况。
设计
病例对照研究。
地点
英国41个产科单位。
参与者
病例为妊娠≥28周发生晚期死产的女性（n = 291），对照为访谈时正在妊娠的女性（n = 733）。对照按产科单位和孕周与病例进行频率匹配。
方法
使用访员管理的问卷收集数据，问卷包括访谈/死产前2周内关于母亲对胎动的感知（频率、强度、胎动增加和减少以及打嗝）的问题。通过合并相似模式和风险组，确定了五种包含过去2周内强度和频率变化的胎动模式。多变量分析对已知混杂因素进行了调整。
主要结局指标
母亲感知的胎动与晚期死产的关联。
结果
在多变量分析中，与胎动无变化的女性相比，报告过去2周内胎动强度增加的女性晚期死产风险降低（调整后比值比（aOR）0.18，95%置信区间0.13至0.26）。胎动频率降低（强度未增加）的女性风险增加（aOR 4.51，95%置信区间2.38至8.55）。每天感知到胎儿打嗝具有保护作用（aOR 0.31，95%置信区间0.17至0.56）。
结论
胎动强度增加和胎儿打嗝与死产风险降低相关。胎动频率的改变对于识别死产风险增加的妊娠很重要，胎动减少的女性风险最高。临床指南应更新，以反映胎动强度和频率增加与最低死产风险相关，而胎动减少与死产相关。
试验注册号
NCT02025530。
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