Sophiahemmet University, Stockholm, Sweden.
Department of Women and Children's Health, Karolinska Institutet, Stockholm, Sweden.
BMC Pregnancy Childbirth. 2020 Oct 1;20(1):577. doi: 10.1186/s12884-020-03268-1.
Maternal perception of decreased fetal movements is commonly used to assess fetal well-being. However, there are different opinions on whether healthcare professionals should encourage maternal observation of fetal movements, as researchers claim that raising awareness increases unnecessary interventions, without improving perinatal health. We aimed to investigate whether cesarean sections and labor induction increase by raising women's awareness of fetal movements through Mindfetalness. Further, we aimed to study perinatal health after implementing Mindfetalness in maternity care.
In a cluster randomized controlled trial, 67 maternity clinics were allocated to Mindfetalness or routine care. In the Mindfetalness group, midwives distributed a leaflet telling the women to focus on the character, strength and frequency of the fetal movements without counting each movement. The instruction was to do so for 15 min daily when the fetus was awake, from gestational week 28 until birth. In this sub-group analysis, we targeted women born in Sweden giving birth from 32 weeks' gestation. We applied the intention-to-treat principle.
The Mindfetalness group included 13,029 women and the Routine-care group 13,456 women. Women randomized to Mindfetalness had less cesarean sections (18.4% vs. 20.0%, RR 0.92, CI 0.87-0.97) and labor inductions (19.2% vs. 20.3%, RR 0.95, CI 0.90-0.99) compared to the women in the Routine-care group. Less babies were born small for gestational age (8.5% vs. 9.3%, RR 0.91, CI 0.85-0.99) in the Mindfetalness group. Women in the Mindfetalness group contacted healthcare due to decreased fetal movements to a higher extent than women in the Routine care group (7.8% vs. 4.3%, RR 1.79, CI 1.62-1.97). The differences remain after adjustment for potential confounders.
Raising awareness about fetal movements through Mindfetalness decreased the rate of cesarean sections, labor inductions and small-for-gestational age babies.
ClinicalTrials.gov ( NCT02865759 ). Registered 12 August 2016, www.clinicaltrials.gov .
孕妇感知胎儿活动减少通常用于评估胎儿健康状况。然而，关于医护人员是否应鼓励孕妇观察胎儿活动存在不同意见，因为研究人员声称，提高意识会增加不必要的干预，而不会改善围产期健康。我们旨在通过 Mindfetalness 研究提高孕妇对胎儿运动的认识是否会导致剖宫产和引产增加。此外，我们旨在研究在产妇护理中实施 Mindfetalness 后的围产期健康。
在一项集群随机对照试验中，将 67 家产科诊所分配到 Mindfetalness 或常规护理组。在 Mindfetalness 组中，助产士分发了一份传单，告诉孕妇关注胎儿运动的特征、强度和频率，而不计算每次运动。指导是在胎儿清醒时每天进行 15 分钟，从妊娠 28 周直到分娩。在这项亚组分析中，我们的目标是在瑞典出生并在 32 周妊娠后分娩的女性。我们应用了意向治疗原则。
Mindfetalness 组包括 13029 名女性，常规护理组包括 13456 名女性。与常规护理组相比，随机分配到 Mindfetalness 组的女性剖宫产（18.4%比 20.0%，RR 0.92，CI 0.87-0.97）和引产（19.2%比 20.3%，RR 0.95，CI 0.90-0.99）的比例较低。在 Mindfetalness 组中，出生时小于胎龄儿的比例较低（8.5%比 9.3%，RR 0.91，CI 0.85-0.99）。与常规护理组相比，Mindfetalness 组因胎儿活动减少而联系医疗保健的女性比例更高（7.8%比 4.3%，RR 1.79，CI 1.62-1.97）。在调整潜在混杂因素后，这些差异仍然存在。
通过 Mindfetalness 提高对胎儿运动的认识，降低了剖宫产、引产和小于胎龄儿的发生率。
ClinicalTrials.gov（NCT02865759）。2016 年 8 月 12 日注册，www.clinicaltrials.gov。
