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?