Conclusion
RFMs is the commonest presentation of stillbirth and a late
manifestation of impending stillbirth. As such RFMs will be more common
in at risk pregnancies. Occasionally, a very unwell baby can be ‘saved’
and so a small reduction in stillbirth could be expected if the symptom
is reported, the fetal illness identified and then appropriately
managed. This would usually be caesarean birth because of an abnormal
antenatal CTG. However, presentation with RFMs, encouraged by awareness
campaigns, is now so common that the absolute risk of pathology is far
lower than it was: a risk factor with such a high incidence is of little
use. Assessment and management of presenting women is causing risk and
this itself could outweigh the potential benefits, perhaps even
explaining the negative recent trial findings. As maternity services try
to reduce stillbirth, both overall intervention and early term birth
rates are increasing in many countries: the risks of these must be
balanced against the risk of stillbirth. The evidence now suggests that
RFMs is a minor, late-onset risk factor and its prioritisation could be
causing harm.
In the UK, NICE summarised their 2021 evidence appraisal12: ‘the committee…formed a
recommendation raising awareness of the lack of evidence of
effectiveness for such packages but not explicitly recommending against
them. ’ Are clinicians and policy makers aware?