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Bradford, B. F., Hayes, D. J., Damhuis, S., Shub, A., Akselsson, A., Rådestad, I., . . . Gordijn, S. J. (2024). Decreased fetal movements: Report from the International Stillbirth Alliance conference workshop. International Journal of Gynecology & Obstetrics, 165(2), 579-585
Open this publication in new window or tab >>Decreased fetal movements: Report from the International Stillbirth Alliance conference workshop
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2024 (English)In: International Journal of Gynecology & Obstetrics, ISSN 0020-7292, E-ISSN 1879-3479, Vol. 165, no 2, p. 579-585Article, review/survey (Refereed) Published
Abstract [en]

Maternal reports of decreased fetal movement (DFM) are a common reason to present to maternity care and are associated with stillbirth and other adverse outcomes. Promoting awareness of fetal movements and prompt assessment of DFM has been recommended to reduce stillbirths. However, evidence to guide clinical management of such presentations is limited. Educational approaches to increasing awareness of fetal movements in pregnant women and maternity care providers with the aim of reducing stillbirths have recently been evaluated in a several large clinical trials internationally. The International Stillbirth Alliance Virtual Conference in Sydney 2021 provided an opportunity for international experts in fetal movements to share reports on the findings of fetal movement awareness trials, consider evidence for biological mechanisms linking DFM and fetal death, appraise approaches to clinical assessment of DFM, and highlight research priorities in this area. Following this workshop summaries of the sessions prepared by the authors provide an overview of understandings of fetal movements in maternity care at the current time and highlights future directions in fetal movement research.

Keywords
Fetal growth restriction, Fetal movements, Pregnancy, Stillbirth
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:shh:diva-5105 (URN)10.1002/ijgo.15242 (DOI)38064233 (PubMedID)
Available from: 2024-01-08 Created: 2024-01-08 Last updated: 2024-05-15Bibliographically approved
Andrén, A., Lindgren, H., Akselsson, A., Rådestad, I. & Erlandsson, K. (2024). One size does not fit all: Perspectives from Swedish midwives on fetal movement counselling. Women and Birth, 37(4), Article ID 101621.
Open this publication in new window or tab >>One size does not fit all: Perspectives from Swedish midwives on fetal movement counselling
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2024 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 37, no 4, article id 101621Article in journal (Refereed) Epub ahead of print
Abstract [en]

PROBLEM: Migration continues to play a role in determining health outcomes related to pregnancy and childbirth in Sweden.

BACKGROUND: Migrant women have, compared to Swedish-born women, increased risks of adverse birth outcomes. Previous research suggests that migrant women seek care for decreased fetal movements less than Swedish-born women. Given these documented risks, understanding midwives' perspectives in this context is crucial to address maternal health inequities.

AIM: To explore midwives' experiences conveying information about fetal movement to migrant women in antenatal healthcare settings.

METHODS: Semi-structured, individual interviews with midwives (n=15) experienced in providing information about fetal movements to migrant women. The interviews were analysed using reflexive thematic analysis.

FINDINGS: The midwives' efforts to compensate for the deficiencies within the antenatal healthcare organisation and to ensure that all women received access to information and care regarding fetal movements are described in four themes: (a) building a trusting relationship; (b) empowering women through guidance and support; (c) overcoming communication challenges; and d) navigating safety measures.

DISCUSSION: Our findings suggest that the standard antenatal care programme does not support midwives to provide holistic and individualised care that aligns with midwifery care philosophy.

CONCLUSION: To reduce health inequities for migrant women, this study highlights the need for more flexible guidelines within the standard antenatal care programme. These guidelines should prioritise the individual woman's needs over institutional protocols, acknowledge the midwife-woman relationship as the core of midwifery practice and support midwives to build a partnership with women through continuity of care.

Keywords
Fetal movements, Maternal health services, Midwife, Migrant, Reflexive thematic analysis, Woman-centred care
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:shh:diva-5357 (URN)10.1016/j.wombi.2024.101621 (DOI)38688145 (PubMedID)
Available from: 2024-06-17 Created: 2024-06-17 Last updated: 2024-06-17Bibliographically approved
Andrén, A., Akselsson, A., Rådestad, I., Ali, S. B., Lindgren, H., Osman, H. M. & Erlandsson, K. (2023). Brister i kommunikationen påverkar hur kvinnor agerar vid minskade fosterrörelser: En intervjustudie med svensksomaliska kvinnor. In: : . Paper presented at Reproduktiv hälsa, Karlstad, 3-4 oktober 2023.
Open this publication in new window or tab >>Brister i kommunikationen påverkar hur kvinnor agerar vid minskade fosterrörelser: En intervjustudie med svensksomaliska kvinnor
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2023 (Swedish)Conference paper, Oral presentation with published abstract (Other academic)
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:shh:diva-5126 (URN)
Conference
Reproduktiv hälsa, Karlstad, 3-4 oktober 2023
Available from: 2024-01-23 Created: 2024-01-23 Last updated: 2024-01-24Bibliographically approved
Bradford, B. F., Cronin, R. S., Warland, J., Akselsson, A., Rådestad, I., Heazell, A. E., . . . McCowan, L. M. (2023). Fetal movements: A framework for antenatal conversations. Women and Birth, 36(3), 238-246, Article ID S1871-5192(22)00321-3.
Open this publication in new window or tab >>Fetal movements: A framework for antenatal conversations
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2023 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 36, no 3, p. 238-246, article id S1871-5192(22)00321-3Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Presentations for decreased fetal movements comprise a significant proportion of acute antenatal assessments. Decreased fetal movements are associated with increased likelihood of adverse pregnancy outcomes including stillbirth. Consensus-based guidelines recommend pregnant women routinely receive information about fetal movements, but practice is inconsistent, and the information shared is frequently not evidence-based. There are also knowledge gaps about the assessment and management of fetal movement concerns. Women have indicated that they would like more accurate information about what to expect regarding fetal movements.

DISCUSSION: Historically, fetal movement information has focussed on movement counts. This is problematic, as the number of fetal movements perceived varies widely between pregnant women, and no set number of movements has been established as a reliable indicator of fetal wellbeing. Of late, maternity care providers have also advised women to observe their baby's movement pattern, and promptly present if they notice a change. However, normal fetal movement patterns are rarely defined. Recently, a body of research has emerged relating to maternal perception of fetal movement features such as strength, presence of hiccups, and diurnal pattern as indicators of fetal wellbeing in addition to frequency.

CONCLUSION: Sharing comprehensive and gestation-appropriate information about fetal movements may be more satisfying for women, empowering women to identify for themselves when their baby is doing well, and importantly when additional assessment is needed. We propose a conversational approach to fetal movement information sharing, focusing on fetal movement strength, frequency, circadian pattern, and changes with normal fetal development, tailored to the individual.

Keywords
Antenatal, Fetal movements, Foetal, Pregnancy, Pregnancy outcome, Prenatal
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:shh:diva-4613 (URN)10.1016/j.wombi.2022.09.003 (DOI)36154793 (PubMedID)
Available from: 2022-10-11 Created: 2022-10-11 Last updated: 2023-05-25Bibliographically approved
Andrén, A., Akselsson, A., Rådestad, I., Ali, S. B., Lindgren, H., Osman, H. M. & Erlandsson, K. (2023). Miscommunication influences how women act when fetal movements decrease: An interview study with Swedish Somali migrant women. Midwifery, 126, Article ID 103796.
Open this publication in new window or tab >>Miscommunication influences how women act when fetal movements decrease: An interview study with Swedish Somali migrant women
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2023 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 126, article id 103796Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVE: To explore how Swedish Somali migrant women perceive fetal movements, process information about fetal movements, and take actions if decreased fetal activity occurs.

DESIGN: A qualitative study based on individual semi-structured interviews. The interviews were analysed using content analysis.

SETTING: The study was conducted in Sweden.

PARTICIPANTS: Swedish Somali migrant women (n=15) pregnant in their third trimester or recently given birth.

FINDINGS: The analysis led to the main category: tailored information about fetal movements enhances the possibility to seek care if the movements decrease. The results are described in the generic categories: explanatory models determine action; and understand and interpret information.

KEY CONCLUSIONS: Miscommunication on fetal movements can be a hurdle for Swedish Somali migrant women that may have impact on stillbirth prevention and the quality of care. Improved communication and information tailored to individual needs is essential to achieve equality for women and their newborns.

IMPLICATIONS FOR PRACTICE: The midwife can be used as a hub for reassuring that adequate information about fetal movements reaches each individual woman in antenatal care. Individualised information on fetal movements based on the women's own understanding is suggested to increase the possibility that the pregnant woman will seek care if the movements decrease. Somali women's verbal communication can be used to spread accurate information in the Somali community on the importance of seeking care if fetal movements decrease.

Keywords
Fetal movement, Midwifery, Migrant health, Qualitative research, Somalia, Stillbirth prevention
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:shh:diva-5011 (URN)10.1016/j.midw.2023.103796 (DOI)37672854 (PubMedID)
Available from: 2023-10-02 Created: 2023-10-02 Last updated: 2023-10-02Bibliographically approved
Andrén, A., Akselsson, A., Rådestad, I., Ali, S. B., Lindgren, H., Osman, H. M. & Erlandsson, K. (2023). Miscommunication influences how women act when fetal movements decrease an interview study with Swedish Somali migrant women. In: : . Paper presented at ISPID International Conference on Stillbirth, SIDS and SUDI, Florens, Italien, 5-8 oktober 2023.
Open this publication in new window or tab >>Miscommunication influences how women act when fetal movements decrease an interview study with Swedish Somali migrant women
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2023 (English)Conference paper, Oral presentation with published abstract (Other academic)
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:shh:diva-5127 (URN)
Conference
ISPID International Conference on Stillbirth, SIDS and SUDI, Florens, Italien, 5-8 oktober 2023
Available from: 2024-01-23 Created: 2024-01-23 Last updated: 2024-01-23Bibliographically approved
Akselsson, A., Rossen, J., Storck-Lindholm, E. & Rådestad, I. (2023). Prolonged pregnancy and stillbirth among women with overweight or obesity: A population-based study in Sweden including 64,632 women. BMC Pregnancy and Childbirth, 23, Article ID 21.
Open this publication in new window or tab >>Prolonged pregnancy and stillbirth among women with overweight or obesity: A population-based study in Sweden including 64,632 women
2023 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 23, article id 21Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The proportion of overweight or obese pregnant women is increasing in many countries and babies born to a mother who is overweight or obese are at higher risk for complications. Our primary objective was to describe sociodemographic and obstetric factors across Body Mass Index (BMI) classifications, with secondary objective to investigate stillbirth and other pregnancy outcomes in relation to BMI classifications and gestational week.

METHODS: This population-based cohort study with data partly based on a cluster-randomized controlled trial includes 64,632 women with singleton pregnancy, giving birth from 28 weeks' gestation. The time period was January 2016 to 30 June 2018 (2.5 years). Women were divided into five groups according to BMI: below 18.5 underweight, 18.5-24.9 normal weight, 25.0-29.9 overweight, 30.0-34.9 obesity, 35.0 and above, severe obesity.

RESULTS: Data was obtained for 61,800 women. Women who were overweight/obese/severely obese had lower educational levels, were to a lesser extent employed, were more often multiparas, tobacco users and had maternal diseases to a higher extent than women with normal weight. From 40 weeks' gestation, overweight women had a double risk of stillbirth compared to women of normal weight (RR 2.06, CI 1.01-4.21); the risk increased to almost four times higher for obese women (RR 3.97, CI 1.6-9.7). Women who were obese or severely obese had a higher risk of almost all pregnancy outcomes, compared to women of normal weight, such as Apgar score < 7 at 5 min (RR1.54, CI 1.24-1.90), stillbirth (RR 2.16, CI 1.31-3.55), transfer to neonatal care (RR 1.38, CI 1.26-1.50), and instrumental delivery (RR 1.26, CI 1.21-1.31).

CONCLUSIONS: Women who were obese or severely obese had a higher risk of almost all adverse pregnancy outcomes and from gestational week 40, the risk of stillbirth was doubled. The findings indicate a need for national guidelines and individualized care to prevent and reduce negative pregnancy outcomes in overweight/obese women. Preventive methods including preconception care and public health policies are needed to reduce the number of women being overweight/obese when entering pregnancy.

Keywords
Body Mass Index, Obesity, Overweight, Pregnancy, Pregnancy outcomes, Stillbirth
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:shh:diva-4753 (URN)10.1186/s12884-022-05340-4 (DOI)36635668 (PubMedID)
Available from: 2023-03-10 Created: 2023-03-10 Last updated: 2024-01-09Bibliographically approved
Andrén, A., Rådestad, I., Lindgren, H., Erlandsson, K. & Akselsson, A. (2023). Ökad uppmärksamhet av fosterrörelser och graviditetsutfall: Ett projekt riktat mot svensksomaliska kvinnor. In: : . Paper presented at Vårmöte i perinatologi, Göteborg, 30-31 mars 2023.
Open this publication in new window or tab >>Ökad uppmärksamhet av fosterrörelser och graviditetsutfall: Ett projekt riktat mot svensksomaliska kvinnor
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2023 (Swedish)Conference paper, Oral presentation only (Other academic)
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:shh:diva-5128 (URN)
Conference
Vårmöte i perinatologi, Göteborg, 30-31 mars 2023
Available from: 2024-01-23 Created: 2024-01-23 Last updated: 2024-01-23Bibliographically approved
Akselsson, A. & Rådestad, I. (2022). Fostrets rörelser (2ed.). In: Helena Lindgren, Kyllike Christensson & Anna-Karin Dykes (Ed.), Reproduktiv hälsa: Barnmorskans kompetensområde (pp. 374-380). Lund: Studentlitteratur AB
Open this publication in new window or tab >>Fostrets rörelser
2022 (Swedish)In: Reproduktiv hälsa: Barnmorskans kompetensområde / [ed] Helena Lindgren, Kyllike Christensson & Anna-Karin Dykes, Lund: Studentlitteratur AB, 2022, 2, p. 374-380Chapter in book (Other academic)
Place, publisher, year, edition, pages
Lund: Studentlitteratur AB, 2022 Edition: 2
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:shh:diva-4690 (URN)9789144138237 (ISBN)
Available from: 2022-12-19 Created: 2022-12-19 Last updated: 2022-12-19Bibliographically approved
Rådestad, I. (2022). Intrauterin fosterdöd (2ed.). In: Helena Lindgren, Kyllike Christensson & Anna-Karin Dykes (Ed.), Reproduktiv hälsa: Barnmorskans kompetensområde (pp. 549-558). Lund: Studentlitteratur AB
Open this publication in new window or tab >>Intrauterin fosterdöd
2022 (Swedish)In: Reproduktiv hälsa: Barnmorskans kompetensområde / [ed] Helena Lindgren, Kyllike Christensson & Anna-Karin Dykes, Lund: Studentlitteratur AB, 2022, 2, p. 549-558Chapter in book (Other academic)
Place, publisher, year, edition, pages
Lund: Studentlitteratur AB, 2022 Edition: 2
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:shh:diva-4691 (URN)9789144138237 (ISBN)
Available from: 2022-12-20 Created: 2022-12-20 Last updated: 2022-12-20Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-9672-7698

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