New strategy to reduce stillbirths remains unproven

By Julie Griffiths on 28 September 2018 Stillbirth Research

A new study trialling a care package aimed at reducing the risk of babies being stillborn offers only a marginal drop say researchers.

The AFFIRM trial sought to test whether, by raising awareness about the importance of fetal movements among pregnant women and health professionals, and introducing a consistent package of care when women present with a history of reduced fetal movements, that stillbirth rates could be reduced.  

The results reveal that the package of care did not lead to a statistically significant reduction in the number of stillbirths, but it did lead to an increase in medical interventions including induction of labour and CS.

There was a marginal drop in the stillbirth rate, from 44 in 10,000 births after standard care to around 41 in 10,000 births with the intervention.

However, induction of labour rose from 35.9% in the control period to 40.7% of births in the intervention period, and CS rose from 25.5% to 28.4% in the intervention period.

There was also an increase in the number of admissions of babies to special care baby units for more than 48 hours after the intervention compared to before.

The large randomised controlled trial included outcomes from more than 409,000 pregnancies in 37 maternity units across the UK.

The RCM said that it fully supports research and quality improvement initiatives to reduce stillbirths and neonatal death, and the AFFIRM trial, with its ‘negative’ result, has made an important contribution to current knowledge and further research into this important topic is always needed.

It added that while the AFFIRM trial suggests that a reliance on reduced fetal movements alone will not lead to a reduction in the number of stillbirths and neonatal deaths there are current quality improvements initiatives underway in the UK.

These include the Maternity and Child Quality Improvement Collaborative in Scotland and the ‘Saving babies lives’ care bundle in England, which are taking a multi-faceted approach to reducing risks. The approaches used include supporting women to give up smoking, improving risk assessment and surveillance of fetal growth, effective monitoring in labour, developing a safety culture with positive multidisciplinary teamworking and implementing continuity of carer, alongside increasing awareness about fetal movements.

The RCM added that the results of this study should not lead to a situation where a woman’s concerns about her baby’s movements are not taken seriously, and it would still encourage all pregnant women to become familiar with their baby’s usual movements and to contact their midwife or maternity unit if they notice a change or reduction.

The organisation also still encourages all midwives, GPs and obstetricians to respond when women describe a reduction in their baby’s movements, taking a careful history and monitoring the baby’s growth, heart rate and activity in a face-to-face assessment.  

The RCM supports ongoing research and quality improvement work alongside its colleagues in the multidisciplinary maternity team. And it hopes that the findings of the AFFIRM trial will be considered carefully and will support health professionals in providing women with evidence-based information to make informed decisions about their care.

The study, published in the Lancet, is available to read here