The AFFIRM (Awareness of Fetal Movements and Care Package to Reduce Fetal Mortality) trial results were published in October 2018 (Norman et al., 2018). The trial showed that an awareness package across maternity hospitals consisting of written information for women and a clinical guideline along with an eLearning program for clinician’s about DFM did not result in a statistically significant reduction stillbirth rates from 24 weeks’ gestation. The trial did show a 9% reduction in stillbirth. However, it was not large enough to confirm this effect statistically. As might be expected with such a package of care, an increase in induction of labour from 35.8% to 40.7%, caesarean section from 25.5% to 28.3% and preterm birth from 8.1% to 8.6%.
The trial was of high quality. However it is unclear how well the intervention was implemented across the 33 maternity services involved. We agree with the trial authors that practice should not change until data are available from other studies currently underway including the My Baby’s Movements (MBM) Trial which is due to completed mid-2019 and reported later in the year. These combined findings will provide the best evidence on the effectiveness of DFM awareness packages as a stillbirth prevention strategy.
Despite the AFFIRM trial results, DFM remains an important risk factor for stillbirth and women and their care providers should remain vigilant and to continue to follow the national guidelines.
Women should continue be advised about the importance of being aware of fetal movements and to report concerns without delay as part of good pregnancy care. The aim of clinical care for women with DFM is to safely prolong pregnancy until 39 to 40 weeks’ gestation.
The new brochure for women on fetal movements (Your Baby’s Movements Matter) is available here.
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