Safer Baby Bundle Element 3: - PowerPoint Presentation

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Safer Baby Bundle Element 3: Decreased Fetal Movements (DFM)

All Local Health Districts that provide maternity care are encouraged to embed the Safer Baby Bundle Elements into routine clinical care

Raising awareness and improving care for women with decreased fetal movements

David Antcliff and Dr Christine Marsh

June 2020

Safer Baby Bundle Element 3

Clinical Excellence Commission

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The EvidenceA prospective, population-based study in Norway reported a fetal death rate in women who had a live fetus at time of presentation with DFM was 8.2 per 1000, compared to 2.9 per 1000 in the general population

A number of studies have identified that an inadequate response to maternal perception of DFM was a common factor contributing to stillbirths

Even in pregnancies that are initially deemed as low risk, DFM is associated with an increased risk of adverse perinatal outcome, including fetal growth restriction, preterm birth and stillbirth.

Clinical Excellence Commission

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"Movements Matter" public awareness campaignClinical Excellence Commission

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http://www.movementsmatter.org.au/

SBB Actions For Implementation1. Provide information brochure and advice on DFM to all pregnant women by the 28th week of pregnancy and remind women of the importance of reporting DFM at every encounter.

2. Undertake clinical examination of all women who report DFM according to the DFM care pathway including risk factor screening for stillbirth.

3. Investigations should include the following: auscultation of fetal heart rate by handheld Doppler, cardiotocography (CTG), consideration of ultrasound for undetected FGR, consideration of fetomaternal haemorrhage (FMH) test.4. Ensure informed, shared decision-making about timing of birth based on gestational age, findings of clinical investigations and the presence or absence of stillbirth risk factors.

Clinical Excellence Commission

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Ensuring health care providers follow the best available evidenceClinical Excellence Commission

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Decreased Fetal Movement Care Pathway

eMaternity/ Cerner Maternity Reports, Surveys & Audits :

1. Proportion of women provided with DFM information by 28 weeks’ gestation.2. Proportion of women with singleton pregnancies who have a CTG commenced within 2 hours of presenting (in person) at the maternity service with DFM, from 28 weeks’ gestation.

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3. Proportion of women reporting no FM are assessed within 2 hours.

4.Proportion of Women reporting at 28 weeks’ gestation or more who attend a maternity service within 12hrs of DFM concern.

Key Performance Indicators

Education and ResourcesClinical Excellence Commission

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Stillbirth CRE ‘Your baby’s movements matter’ brochure (translated into 20 languages)

Safer Baby Bundle educational program for maternity care providers: eLearning DFM chapter

Resources and collaterals for women and maternity care providers

DFM Care Pathway for singleton pregnancies from 28+0 weeks

NSW Health DFM Guideline

Perinatal Safety Education training (My Health Learning)

Clinical Excellence Commission

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This presentation acknowledges the contribution of others who provided materially to the February 2020 Learning Sets for the NSW Safer Baby Bundle Research sites Contact DetailsDr Christine MarshImprovement Lead

Clinical Excellence Commission

Email:

CEC-saferbabybundle@health.nsw.gov.au

Web:

http://www.cec.health.nsw.gov.au/keep-patients-safe/Maternity-Safety-Program