Kuile, M. ter (Madeleine) (2017) Investigating the cause of stillbirths preceded by reduced fetal movements: a case-control study. thesis, Medicine.
Full text available on request.Abstract
Background: Stillbirth has been an extensive problem and efforts for improvement are highly necessary. The maternal report of reduced fetal movements (RFM) is one way to identify a compromised fetus. Currently there are no studies which investigate the associations with RFM in stillbirth. It is hypothesised that RFM is associated with placental insufficiency and fetal growth restriction (FGR). Methods: A case-control study was carried out using a database of 301 stillbirths, divided into three groups: 109 with RFM, 33 with absent fetal movements (AFM) and 159 with no evidence of RFM (NE). Maternal, fetal and medical and pregnancy-related factors were investigated. Logistic regression was used to determine the strength of associations. Results: Pregnancies with RFM were independently less frequently associated with proteinuria, previous pregnancy loss <24 weeks and more frequently associated with placental insufficiency. Significant, however not independent factors associated with RFM were smaller gravidity, hypertension and the interaction between hypertension and proteinuria. When combined, AFM and RFM showed less twin pregnancies than NE and fewer intrapartum stillbirths. There was no relationship between RFM and maternal factors: age, parity, BMI, ethnicity, blood group, presence of rhesus D antigen and consanguinity. There was also no relationship between pregnancy-related and fetal factors: gestational age, IVF pregnancies, smoking, alcohol, drugs, OGTT, fetal gender, birthweight, placental weight and feto:placental weight ratio. No association was found with FGR defined as birthweight <10th centile. Conclusions: The association between RFM and placental insufficiency was confirmed in cases of stillbirth. This provides further evidence that RFM is a symptom of placental insufficiency. Therefore, RFM should be taken seriously and adequate investigation and intervention should be carried out after RFM.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty supervisor: and Erwich, Prof. J.J.H.M. MD |
| Supervisor name: | Supervisor: and Heazell, Prof. dr. A.E.P. MBChB PhD MRCOG and Maternal & Fetal Health Research Centre, St. Mary’s Hospital |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:39 |
| Last Modified: | 25 Jun 2020 10:39 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/60 |
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