Are RFM initiatives effective?
Randomised trials and ‘impact’ studies have assessed either
self-monitoring or clinical advice for management of RFM, or both. The
impact studies of combined packages of awareness and intervention are
complex, but benefits have been concluded. However, the most recent and
therefore applicable, with 8821 women with RFMs, reported no reduction
in perinatal mortality 1. Indeed, excluding the
pregnancies where RFMs was the presentation of stillbirth, they reported
no increased risk of stillbirth with RFMs.
The interventions in recent trials, Saastad et al 2and the Swedish Mindfulness trial 3 encouraged
self-monitoring only. By contrast, both this and a clinical ‘package’
were implemented in the UK AFFIRM study 4 and the
Australasian My Babies Movements 5, stepped wedge
cluster randomised trials of over 400 000 and nearly 300 000
participants respectively. None of these trials reported reduced
perinatal mortality. Systematic review and metanalysis6 including smaller trials (but not the Australasian
study), reported a possible reduction in stillbirth (RR 0.92;
0.85-1.00), but increased intervention rates. But any policy, which
increases intervention to expedite birth at or near term should reduce
perinatal mortality: routine induction of labour from 37 weeks does just
that (RR 0.31; 0.15 -0.64).
Of course, these trials did not compare fetal movement monitoring with
advice to ignore movements: ‘usual care’ increasingly constitutes a
relatively high awareness of RFMs. But the evidence suggests that,
barring when RFMs is the actual presentation of stillbirth, RFMs
constitute a minor risk factor when compared, say, to other established
risk factors such as reaching 42 or even 41 weeks.