How does this relate to stillbirth and stillbirth research I hear you asking?
Recently this article came up in my “citation alerts.” It’s a report of a trial conducted in the UK of increased fetal movements which was designed to prospectively examine outcomes from women who report an increase in fetal movements (IFM). The authors reported there was not a significant relationship between woman who report IFM and poor pregnancy outcomes.
This study is a classic example of referring to the black box rather than the pilot. They actually thoroughly examined the black box (the CTG, the woman’s blood, the placenta and pregnancy outcomes). What they didn’t do was ask their participants for a qualitative description of the movements. They actually admit this is a limitation:
Furthermore, this study did not include a qualitative description of IFM which is potentially important in determining their significance with regards to stillbirth [Warland et al 2015]
“Potentially important” is something of an understatement. “Vitally import” would have been more accurate!
What information did the authors miss out on? Well they actually allude to this in the reference they cite. That paper, one that I am pretty familiar with :) , gives crucial information about descriptors women use for IFM which probably indicate fetal health and when they, potentially, don’t. Women who experience stillbirth use descriptors for IFM like “crazy” wild” ballistic” nuts” “bananas” over a very short period of time. The authors of this new study suggest that women presented to the hospital with a period of IFM lasting 1 to 24 hours. This is therefore not likely to be the short “crazy” increase we reported as possibility associated with stillbirth in 2015. In fact, it seems pretty likely to me that this study picked a group of women who were reporting an increase in their baby’s movements that was actually demonstrating their baby was healthy and well BUT because these authors didn’t ask the woman for her qualitative description we wont know how many, if any, of them might have been using those key words versus the others who might have been using words known to be associated with fetal health like “strong and vigorous.” Certainly, you wouldn’t think that a baby in trouble would be able to sustain a increase in fetal movement for a period of 24 hours!
The authors of this study call for additional prospective studies which incorporate women’s description of fetal activity to differentiate between women’s experienced of IFM. All I can say is “hear hear” to that idea!