Awareness of Fetal Movements and Care Package to Reduce Fetal Mortality (AFFIRM)

BackgroundIn 2013, the stillbirth rate in the UK was 4.2 per 1000 live births, ranking 24th out of 49 high-income countries, with an annual rate of reduction of only 1.4% per year. The majority of stillbirths occur in normally formed infants, with (retrospective) evidence of placental insufficiency the most common clinical finding. Maternal perception of reduced fetal movements (RFM) is associated with placental insufficiency and increased risk of subsequent stillbirth.This study will test the hypothesis that the introduction of a package of care to increase women's awareness of the need for prompt reporting of RFM and standardised management to identify fetal compromise with timely delivery in confirmed cases, will reduce the rate of stillbirth. Following the introduction of a similar intervention in Norway the odds of stillbirth fell by 30%, but the efficacy of this intervention (and possible adverse effects and implications for service delivery) has not been tested in a randomised trial.MethodsWe describe a stepped-wedge cluster trial design, in which participating hospitals in the UK and Ireland will be randomised to the timing of introduction of the care package. Outcomes (including the primary outcome of stillbirth) will be derived from detailed routinely collected maternity data, allowing us to robustly test our hypothesis. The degree of implementation of the intervention will be assessed in each site. A nested qualitative study will examine the acceptability of the intervention to women and healthcare providers and identify process issues including barriers to implementation.Ethics and disseminationEthical approval was obtained from the Scotland A Research Ethics Committee (Ref 13/SS/0001) and from Research and Development offices in participating maternity units. The study started in February 2014 and delivery of the intervention completed in December 2016. Results of the study will be submitted for publication in peer-reviewed journals and disseminated to local investigating sites to inform education and care of women presenting with RFM.Trial registration numberwww.clinicaltrials.govNCT01777022.VersionProtocol Version 4.2, 3 February 2017.

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LB02: The AFFIRM study: Can promoting awareness of fetal movements and focusing interventions reduce fetal mortality? A stepped-wedge cluster randomised trial

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2017.11.597 ◽

2018 ◽

Vol 218 (1) ◽

pp. S603 ◽

Cited By ~ 5

Author(s):

Jane E. Norman ◽

Alexander EP Heazell ◽

Aryelly Rodriguez ◽

Christopher J. Weir ◽

Sarah JE Stock ◽

...

Keyword(s):

Randomised Trial ◽

Cluster Randomised Trial ◽

Fetal Mortality ◽

Stepped Wedge ◽

Cluster Randomised ◽

Fetal Movements

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The challenge of fetal mortality

PsycEXTRA Dataset ◽

10.1037/e565172009-001 ◽

2009 ◽

Cited By ~ 8

Author(s):

Marian F. MacDorman ◽

Sharon Kirmeyer

Keyword(s):

Fetal Mortality

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FETAL MOVEMENTS AS AN INDICATOR OF FETAL WELLBEING

The Lancet ◽

10.1016/s0140-6736(80)91681-5 ◽

1980 ◽

Vol 315 (8180) ◽

pp. 1222-1224 ◽

Cited By ~ 91

Author(s):

Steen Neldam

Keyword(s):

Fetal Movements ◽

Fetal Wellbeing

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Economic assessment of a community-based care package for people with lower limb disorder caused by lymphatic filariasis, podoconiosis and leprosy in Ethiopia

Transactions of the Royal Society of Tropical Medicine and Hygiene ◽

10.1093/trstmh/traa111 ◽

2020 ◽

Vol 114 (12) ◽

pp. 1021-1034

Author(s):

Natalia Hounsome ◽

Mersha Kinfe ◽

Maya Semrau ◽

Oumer Ali ◽

Abraham Tesfaye ◽

...

Keyword(s):

Quality Of Life ◽

Lymphatic Filariasis ◽

Lower Limb ◽

Life Quality ◽

Psychosocial Care ◽

Northwest Ethiopia ◽

World Health ◽

Care Package ◽

The Cost

Abstract We conducted an implementation research study to integrate a holistic package of physical health, mental health and psychosocial care for podoconiosis, lymphatic filariasis and leprosy into routine healthcare in Gusha cluster, Guagusa Shikudad district, northwest Ethiopia. The healthcare package included training patients in lower limb hygiene and skin care and provision of shoes, hygiene supplies and medication. The implementation activities included training events, workshops, awareness raising, self-help groups, supportive supervision, staff secondments and advisory board meetings. The cost of implementing the care package in Gusha cluster, with a population of 30 558 people, was 802 655 Ethiopian birr (ETB) (£48 159) and the cost of delivering care to 235 participants was 204 388 ETB (£12 263), or 870 ETB (£52) per person. There was a 35% decrease in the mean disability scores (measured using the World Health Organization Disability Assessment Schedule 2.0) and a 45% improvement in the dermatology-specific quality of life (measured using the Dermatology Life Quality Index) at the 3-month follow-up compared with baseline. There were reductions in the number of days with symptoms, days off usual activities/work and days with reduced activity due to illness, all of which were statistically significant. Our pilot suggests that integration of the care package into routine healthcare in Ethiopia may be effective in improving health-related quality of life and disability and reducing time out of economic activity due to illness.

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Massive Perivillous Fibrin Deposition and Chronic Histiocytic Intervillositis a Complication of SARS-CoV-2 Infection

Pediatric and Developmental Pathology ◽

10.1177/10935266211020723 ◽

2021 ◽

pp. 109352662110207

Author(s):

T Marton ◽

B Hargitai ◽

K Hunter ◽

M Pugh ◽

P Murray

Keyword(s):

Placental Insufficiency ◽

Intrauterine Death ◽

Fibrin Deposition ◽

Fetal Demise ◽

Trophoblastic Cells ◽

Stage Disease ◽

Villous Trophoblast ◽

Fetal Movements ◽

Active Viral Replication ◽

End Stage

An emerging complication of COVID-19 (SARS-CoV-2) infection is reported. A 23-year-old patient presented with high temperature and reduced fetal movements at 25 + 5/40 weeks of gestation. RT-PCR proved maternal COVID-19 infection. Ultrasound examination confirmed intrauterine death. Placenta histology showed necrosis of the villous trophoblast, associated with Chronic Histiocytic Intervillositis (CHI) and Massive Perivillous Fibrin Deposition (MPFD) with up to 90% - of the intervillous spaces being involved. Immunohistochemistry showed CD68 positive histiocytes in the intervillous spaces and the villous trophoblast was positive for the COVID-19 spike protein. RNA scope signal was indicative of the presence of the viral genome and active viral replication in the villous trophoblastic cells, respectively. MPFD is a gradually developing end-stage disease with various etiology, including autoimmune and alloimmune maternal response to antigens expressed at the feto-maternal interface and frequently accompanies chronic alloimmune villitis or histiocytic intervillositis. Covid-19 infection is associated with similar pattern of histological changes of the placenta leading to placental insufficiency and fetal death. This case report supports maternal- fetal vertical transmission of SARS-CoV-2 virus leading to placental insufficiency and fetal demise. MPFD and CHI appear to be the typical placental histology for SARS-CoV-2 virus infection associated fetal demise.

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Absence of Wharton’s jelly

BMJ Case Reports ◽

10.1136/bcr-2020-237222 ◽

2020 ◽

Vol 13 (11) ◽

pp. e237222

Author(s):

Sarah J Murphy ◽

Nikita Deegan ◽

Bobby D O'Leary ◽

Peter McParland

Keyword(s):

Caesarean Section ◽

Histological Examination ◽

Umbilical Cord ◽

Emergency Caesarean Section ◽

Wharton’S Jelly ◽

Female Infant ◽

Fetal Bradycardia ◽

Wharton's Jelly ◽

Emergency Caesarean ◽

Fetal Movements

Wharton’s jelly is a specialised tissue which surrounds the vasculature within the fetal umbilical cord. We present the case of a 42-year-old woman who gave birth to a female infant via emergency caesarean section. At the time of delivery, absence of Wharton’s jelly was noted. This finding was confirmed by histological examination. Emergency caesarean section was necessitated due to a fetal bradycardia, and of note, the patient had presented twice prior to this with reduced fetal movements.

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Fetal movement counting is associated with the reduction of delayed maternal reaction after perceiving decreased fetal movements: a prospective study

Scientific Reports ◽

10.1038/s41598-021-90240-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Shigeki Koshida ◽

Shinsuke Tokoro ◽

Daisuke Katsura ◽

Shunichiro Tsuji ◽

Takashi Murakami ◽

...

Keyword(s):

Pregnant Women ◽

Maternal Behavior ◽

Multivariable Analysis ◽

Perinatal Outcomes ◽

Fetal Movement ◽

Post Intervention ◽

Fetal Movements ◽

Adverse Perinatal Outcomes ◽

The Impact ◽

Maternal Reaction

AbstractMaternal perception of decreased fetal movement is associated with adverse perinatal outcomes. Although there have been several studies on interventions related to the fetal movements count, most focused on adverse perinatal outcomes, and little is known about the impact of the fetal movement count on maternal behavior after the perception of decreased fetal movement. We investigated the impact of the daily fetal movement count on maternal behavior after the perception of decreased fetal movement and on the stillbirth rate in this prospective population-based study. Pregnant women in Shiga prefecture of Japan were asked to count the time of 10 fetal movements from 34 weeks of gestation. We analyzed 101 stillbirths after the intervention compared to 121 stillbirths before the intervention. In multivariable analysis, maternal delayed visit to a health care provider after the perception of decreased fetal movement significantly reduced after the intervention (aOR 0.31, 95% CI 0.11–0.83). Our regional stillbirth rates in the pre-intervention and post-intervention periods were 3.06 and 2.70 per 1000 births, respectively. Informing pregnant women about the fetal movement count was associated with a reduction in delayed maternal reaction after the perception of decreased fetal movement, which might reduce stillbirths.

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