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# **Clinical Practice Guideline for the Care of Women with Decreased Fetal Movements** *Developed in partnership with:*
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## **Produced by:** This clinical guideline was produced by a multidisciplinary working group led by the Mater Research Institute, The University of Queensland, Brisbane, Australia, under the auspices of the Stillbirth and Neonatal Death Alliance (SANDA) of the Perinatal Society of Australia and New Zealand (PSANZ) in...
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#### **Endorsed by:** The clinical guideline has been endorsed by: Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG); Australian College of Midwives (ACM); Stillbirth Foundation Australia; Australian National Council for Stillbirth and Neonatal Death Support (SANDS); Red Nose; Wome...
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## **Suggested citation:** Gardener G, Daly L, Bowring V, Burton G, Chadha Y, Ellwood D, Frøen F, Gordon A, Heazell A, McDonald S, Mahomed K, Norman JE, Oats J, Flenady V. *Clinical practice guideline for the care of women with decreased fetal movements*. Centre of Research Excellence in Stillbirth. Brisbane, Australi...
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## **Further review and information:** This guideline will remain current until the next review on or before **August 2018**. Requests for further information, comments or suggestions are encouraged and can be forwarded to: *Centre of Research Excellence in Stillbirth Mater Research Institute Level 3, Aubigny Place S...
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#### **1.1 Aims and objectives** The aim of this guideline is to improve the quality of care for women with DFM, and has been developed with the following objectives: - Provide an evidence-based approach to the management of women with DFM; - Improve consistency in the management of women with DFM; - Assist health ca...
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## **1.2 Target audience** This guideline targets health care professionals providing antenatal care in Australia and New Zealand and encourages them to provide consistent, best-practice management for women with singleton pregnancies who report or who are concerned about DFM in the third trimester of pregnancy. Pregn...
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#### **2.1 Recommendations for fetal movement monitoring** | Recommendations | Evidence level and references* | Recommendation grade* | |--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------...
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#### **2.1 Recommendations for fetal movement monitoring** | Recommendations | Evidence level and references* | Recommendation grade* | |--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------...
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#### **2.1 Recommendations for fetal movement monitoring** | Recommendations | Evidence level and references* | Recommendation grade* | |--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------...
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#### **2.1 Recommendations for fetal movement monitoring** | Recommendations | Evidence level and references* | Recommendation grade* | |--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------...
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#### **2.1 Recommendations for fetal movement monitoring** | Recommendations | Evidence level and references* | Recommendation grade* | |--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------...
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#### **2.1 Recommendations for fetal movement monitoring** | Recommendations | Evidence level and references* | Recommendation grade* | |--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------...
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#### **2.1 Recommendations for fetal movement monitoring** | Recommendations | Evidence level and references* | Recommendation grade* | |--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------...
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#### **2.2 Recommendations for the investigation of decreased fetal movements** | Recommendations | Evidence level and references* | Recommendation grade* | | |------------------------------------------------------------------------------------------------------------------------------------------|--------------------...
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#### **2.2 Recommendations for the investigation of decreased fetal movements** | Recommendations | Evidence level and references* | Recommendation grade* | | |------------------------------------------------------------------------------------------------------------------------------------------|--------------------...
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#### **2.2 Recommendations for the investigation of decreased fetal movements** | Recommendations | Evidence level and references* | Recommendation grade* | | |------------------------------------------------------------------------------------------------------------------------------------------|--------------------...
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#### **2.2 Recommendations for the investigation of decreased fetal movements** | Recommendations | Evidence level and references* | Recommendation grade* | | |---------------------------------------------------------------------------------------------------------------------------------------------------------------...
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#### **2.2 Recommendations for the investigation of decreased fetal movements** | Recommendations | Evidence level and references* | Recommendation grade* | | |---------------------------------------------------------------------------------------------------------------------------------------------------------------...
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#### **2.2 Recommendations for the investigation of decreased fetal movements** | Recommendations | Evidence level and references* | Recommendation grade* | | |---------------------------------------------------------------------------------------------------------------------------------------------------------------...
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#### **2.2 Recommendations for the investigation of decreased fetal movements** | Recommendations | Evidence level and references* | Recommendation grade* | | |---------------------------------------------------------------------------------------------------------------------------------------------------------------...
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#### **2.2 Recommendations for the investigation of decreased fetal movements** Appendix D offers a description of evidence classification levels and grading of recommendations used in this guideline.
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## **2.3 Care pathway for women presenting with decreased fetal movements from 28 weeks' gestation** Disclaimer: This algorithm is for general guidance only and is subject to a clinician's expert judgement. The algorithm should not be relied on as a substitute for clinical advice.
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#### **Advice to pregnant women** - Be aware of baby's movements daily - Provide PSANZ patient information brochure (https://sanda.psanz.com.au/parent-centre/pregnancy/) - Women with concerns about decreased or absent fetal movements should be advised to contact their health care provider immediately. - Women with con...
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#### **Risk factors for stillbirth** - Previous stillbirth - Fetal growth restriction and Small for gestational age - Antepartum haemorrhage - Diabetes - Hypertension - Parity of 0 or >3 - Advanced maternal age (>35 years) - IVF - Indigenous ethnicity - Maternal obesity (BMI >25) - Smoking or illicit drug use - Low so...
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#### **Examination** - Abdominal palpation to assess uterine tone & tenderness, fetal lie/presentation - Symphyseal fundal height (SFH) to be measured in centimetres & plotted on growth chart - Handheld ultrasound Doppler is recommended, not auscultation with a stethoscope or Pinards. - Record maternal pulse rate & co...
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#### **CTG** - Perform within 2 hours of presentation - Perform for at least 20 mins or until satisfactory. - Use maternal fetal movement recorder during CTG
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#### **Ultrasound** - Consider ultrasound within 24 hours. - Include fetal biometry, amniotic fluid volume, and morphology (if not already performed). - Placental and fetal Doppler assessment, as indicated. - The timeframe to perform this investigation will depend on the clinical circumstances and availability of appr...
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#### **Fetal to maternal haemorrhage** - Perform Kleihauer test or flow cytometry test, where feasible. - MCA Doppler assessment may be performed where expertise in ultrasonography is available.
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## 3.1 Maternal perception of fetal movement and adverse events Maternal perception of fetal movement has long been used as an indicator of fetal wellbeing and vitality. The quality and timing of fetal movements reflects neurobehavioural development and maturation of the fetus, and follows a general pattern with advan...
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## 3.1 Maternal perception of fetal movement and adverse events lect increasing strength, more complex limb and trunk movements and greater frequency. In a qualitative study of 40 women within 2 weeks of delivery of uncomplicated pregnancies, 39 of the women described the fetal movements at this stage as "strong and p...
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## 3.1 Maternal perception of fetal movement and adverse events Studies conducted on the correlation between maternal perception of fetal movements and fetal movements seen on ultrasound scans demonstrated large variations, with correlation rates between maternal perception and actual fetal movement ranging from 16-90...
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## 3.1 Maternal perception of fetal movement and adverse events Other considerations that complicate the interpretation of fetal health based on the number of fetal movements are the limited understanding of patterns of fetal activity during "sleep" and active cycles, and the changes in the type of movements as pregna...
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## 3.1 Maternal perception of fetal movement and adverse events Maternal perception of a gradual diminishment of fetal activity can indicate pregnancies at increased risk of adverse outcomes. Studies have reported associations between DFM and low birth weight, oligohydramnios, preterm birth, threatened preterm labour,...
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## 3.1 Maternal perception of fetal movement and adverse events Fetal growth restriction appears to be a major factor contributing to the increased risk of adverse outcomes in these pregnancies. A case-control study from the UK reported that FGR was present in 11% of women with DFM compared with 0% in the control grou...
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## 3.1 Maternal perception of fetal movement and adverse events DFM is a common cause for maternal concern, with 40 percent of pregnant women overall expressing concern about DFM one or more times during pregnancy, and 4-16% of women contacting their health care provider because of concern during the third trimester. ...
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## 3.1 Maternal perception of fetal movement and adverse events 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.
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## 3.2 Perinatal mortality in Australia and New Zealand Stillbirth affects over 2,500 families per year across Australia and New Zealand. One baby is stillborn for every 142 births across Australia. Fetal death rates have failed to show any significant reduction for more than a decade, while the decline in perinatal a...
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## 3.2 Perinatal mortality in Australia and New Zealand Across various studies, the wide variation in the reported contribution of *unexplained* stillbirths from 15% to 71% has been attributed to varying classification systems used, thoroughness of the investigation of deaths and the various definitions of stillbirth....
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## 3.2 Perinatal mortality in Australia and New Zealand Other factors which are associated with an increased risk of stillbirth in a high-income country setting include: maternal age older than 35 years; maternal overweight and obesity; maternal smoking; primiparity; previous stillbirth; and pre-existing maternal diab...
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#### 3.3 Clinical assessment of fetal movement concerns Despite the apparent increased risk associated with maternal perception of DFM, a Norwegian study reported that one in four women could not recall having received any information about fetal movements during routine antenatal care. Furthermore, existing guideline...
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#### 3.3 Clinical assessment of fetal movement concerns Wide variation in clinical practice regarding the management of DFM was shown in a recent survey of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), as well as in a similar survey for midwives in Australia and New Zealan...
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#### 3.3 Clinical assessment of fetal movement concerns These findings are consistent with other similar surveys from the UK and Norway. Variation in clinical practice was also confirmed in another Australian study. In this clinical audit of practice across six public hospitals in Queensland, 6-8% of pregnant women re...
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#### 3.3 Clinical assessment of fetal movement concerns Contributing factors relating to suboptimal care account for 30-50% of stillbirths and neonatal deaths68, 78, 79 . A number of studies in Norway identified that an inappropriate response to maternal perception of DFM was a common factor contributing to stillbirth...
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## **3.4 Investigations of DFM prior to 28 weeks' gestation** There is currently insufficient evidence to inform the management of women who report DFM prior to 28 weeks gestation. Between 20 and 28 weeks gestation, conditions predisposing to DFM, e.g. fetal neuromuscular abnormalities, fetal anaemia, fetal hydrops an...
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## **Defining DFM and maternal perception of fetal activity** | Recommendations | Evidence level and references | Recommendation grade | |-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------...
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## **Defining DFM and maternal perception of fetal activity** | Recommendations | Evidence level and references | Recommendation grade | |-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------...
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## **Defining DFM and maternal perception of fetal activity** Attempts have been made to define normal patterns of fetal movements, but there is no universallyagreed definition of DFM. One definition of DFM comes from Moore et al who propose "less than 10 movements within 2 hours when the fetus is active"14. This is a...
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## **Defining DFM and maternal perception of fetal activity** In a study of women with normal, uncomplicated pregnancies, 99% of women were able to feel 10 movements within 60 minutes . Another study of 705 women with low-risk pregnancy aimed to establish a reference value for perceived fetal movements in the second h...
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## **Defining DFM and maternal perception of fetal activity** Antenatal education about fetal movement has been shown to reduce the time from maternal perception of DFM to health care-seeking behaviour . A reduction in stillbirth rates has been associated with increased awareness of DFM in a recent quality improvement...
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## **Defining DFM and maternal perception of fetal activity** However, despite this link between maternal awareness of fetal movement, clinical education and stillbirth prevention, many women do not receive adequate information from their care providers83, . A recent prospective, descriptive study of 526 pregnant wome...
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## **Defining DFM and maternal perception of fetal activity** Women with DFM who ask for advice are often told that their baby may respond with movements within 20 minutes after having something sweet to eat, or after having an icy, cold drink. However, there is no evidence available to support this advice. Fetal move...
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## **The role of formal fetal movement counting** | Recommendation 3 | Evidence level and references | Recommendation grade | |----------------------------------------------------------------------------------------------------|----------------------------------|-------------------------| | a. Maternal concern of DFM ...
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## **The role of formal fetal movement counting** A recent Cochrane review assessed the effect of formal fetal movement counting on perinatal death, major morbidity, maternal anxiety and satisfaction, pregnancy intervention and other adverse pregnancy outcomes, using five randomised trials, involving a total of 71,458...
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## **The role of formal fetal movement counting** The largest study included in this review was the cluster-randomised trial by Grant *et al* comparing formal fetal movement counting (using the Cardiff method) versus no instruction to monitor fetal movements. The control group in this study included selective use of c...
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## **The role of formal fetal movement counting** The large trial by Grant et al contributing largely to the Cochrane Review findings, however, deserves closer review. This multicentre cluster randomised controlled trial was conducted to investigate the role of fetal movement counting in 68,654 women of at least 28 we...
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## **The role of formal fetal movement counting** d towards more antenatal admissions in the fetal movement counting group than in the control group. Further, there was an increased use of other fetal testing methods, with more women having cardiotocography in the fetal movement counting group than in the group where ...
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## **The role of formal fetal movement counting** However, a more recent study in Norway demonstrated that a modified count-to-10 method of fetal movement counting may have contributed to a significant increase in antenatal detection of fetal growth restriction . A multi-centre, randomized controlled trial of 1,076 pr...
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## **The role of formal fetal movement counting** ied antenatally in the control group, with no increase in consultations or obstetric interventions. This trial also corroborates previous findings that fetal movement counting has not proven to increase maternal concern, anxiety, or risk of being examined in hospital .
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## **The role of formal fetal movement counting** This finding dispels the concern about the introduction of formal fetal movement counting as a part of routine antenatal care, related to its potential to result in an increased number of antenatal hospital visits, interventions and costs without additional benefit. In...
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#### **6.1 Fetal heart rate monitoring** | Recommendations | Evidence level and references | Recommendation grade | | |------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------|-------------------------|...
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#### **6.1 Fetal heart rate monitoring** | Recommendations | Evidence level and references | Recommendation grade | | |------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------|-------------------------|...
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#### **6.1 Fetal heart rate monitoring** | Recommendations | Evidence level and references | Recommendation grade | | |------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------|-------------------------|...
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#### **6.1 Fetal heart rate monitoring** | Recommendations | Evidence level and references | Recommendation grade | | |------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------|-------------------------|...
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#### **6.1 Fetal heart rate monitoring** | Recommendations | Evidence level and references | Recommendation grade | | |------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------|-------------------------|...
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#### **6.1 Fetal heart rate monitoring** | Recommendations | Evidence level and references | Recommendation grade | | |------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------|-------------------------|...
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#### **6.1 Fetal heart rate monitoring** | Recommendations | Evidence level and references | Recommendation grade | | |------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------|-------------------------|...
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#### **6.1 Fetal heart rate monitoring** | Recommendations | Evidence level and references | Recommendation grade | | |------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------|-------------------------|...
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#### **6.1 Fetal heart rate monitoring** | Recommendations | Evidence level and references | Recommendation grade | | |------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------|-------------------------|...
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#### **6.1 Fetal heart rate monitoring** | Recommendations | Evidence level and references | Recommendation grade | | |------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------|-------------------------|...
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#### **6.1 Fetal heart rate monitoring** The first step in the management of DFM is to ensure the fetus is alive and not in imminent danger of death. Once death is excluded, any coincidental associated pathology should also be excluded as a possible cause for DFM.
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#### **6.1 Fetal heart rate monitoring** A handheld Doppler can immediately confirm the presence of a fetal heartbeat. In doubtful cases, cardiotocography (CTG) may be required to detect a fetal heart beat and to establish the fetal heart rate (FHR) pattern. In both situations, a fetal heartbeat needs to be differenti...
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#### **6.1 Fetal heart rate monitoring** The presence of a normal FHR pattern (i.e. showing accelerations in fetal heart rate coinciding with fetal movements and the absence of decelerations) is a positive indicator of fetal wellbeing and suggests a normally functioning autonomic nervous system . The fetal heart rate ...
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#### **6.1 Fetal heart rate monitoring** Although CTG has become part of clinical practice, a Cochrane review comprising 4 trials and 1588 women did not confirm or refute any benefits for routine antepartum CTG monitoring of "at-risk" pregnancies. However, the authors acknowledge several limitations of this review, in...
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#### **6.1 Fetal heart rate monitoring** ls were conducted in the early 1980s when these tests were first introduced into clinical practice. However, a 2011 retrospective, population-based cohort study of women presenting with maternal perception of DFM during the third trimester found that the CTG was a reliable scre...
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#### **6.1 Fetal heart rate monitoring** Recent non-randomised studies have reported benefits of screening low- and at-risk pregnancies using CTG monitoring for the indication of DFM. For example, in a Norwegian study of 3014 women reporting DFM, a CTG was performed in 97.5% of cases and an abnormal result was detecte...
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#### **6.1 Fetal heart rate monitoring** es), after a normal and abnormal CTG, were 1.9 and 26 per 1000 births, respectively . Although the evidence on the effectiveness of CTG monitoring in the identification of "at-risk" babies remains inconclusive, the use of CTG as a screening tool can be justified, as an abnormal...
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## **6.2 Ultrasound scans for DFM** | Recommendations | Evidence level and references | Recommendation grade | | |-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------...
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## **6.2 Ultrasound scans for DFM** | Recommendations | Evidence level and references | Recommendation grade | | |-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------...
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## **6.2 Ultrasound scans for DFM** | Recommendations | Evidence level and references | Recommendation grade | | |-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------...
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## **6.2 Ultrasound scans for DFM** In a Norwegian study, an investigation protocol of CTG and ultrasound scan was used in the management of women reporting DFM. The study recommended that both investigations should be performed within 2 hours if women reported *no fetal movements* and within 12 hours if they reported...
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## **6.2 Ultrasound scans for DFM** Another study of 489 women reporting DFM demonstrated that women reporting DFM, but no other pregnancy risk factor, did not require further follow-up once the CTG and the amniotic fluid volume were confirmed as normal. An ultrasound scan was performed to assess amniotic fluid. Women...
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## **6.3 Fetal to maternal haemorrhage and DFM** | Recommendation 11 | Evidence level and references | Recommendation grade | |-----------------------------------------------------------------------------------------------------------------------|----------------------------------|-------------------------| | Testing ...
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## **6.3 Fetal to maternal haemorrhage and DFM** A sinusoidal FHR pattern is the classically described CTG sign indicating severe fetal anaemia , however, this is not present in all cases. A recent study demonstrated that among a population associated with severe fetal anaemia, only 12.5% of cases demonstrated a sinus...
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## **6.3 Fetal to maternal haemorrhage and DFM** Testing for FMH from a sample of the mother's blood is widely available by flow cytometry or the Kleihauer test. Where ultrasound facilities and appropriate expertise are available, assessment for fetal anaemia can be undertaken by Doppler measurement of the fetal middl...
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## **Ongoing maternal concern about DFM** Following exclusion of fetal compromise at an initial episode of DFM, maternal concern of DFM may persist or may result in subsequent consultations for DFM. To date, few studies guide the management of women who have ongoing concern about DFM. A small retrospective study, invo...
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## **Ongoing maternal concern about DFM** likely to have had high second-trimester uterine artery Doppler resistance indices . This study concluded that women presenting with repeated DFM episodes should be considered at high risk for placental dysfunction irrespective of antenatal ultrasound or Doppler assessment res...
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# **Discussion: Implementation and future research** Leading international authorities have recommended that women experiencing DFM should notify their health care providers as soon as reasonably possible. However, beyond this recommendation, there is limited guidance for clinicians on how to manage this presentation,...
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# **Discussion: Implementation and future research** The recommendations of this guideline cover two key areas: 1) information for pregnant women about what constitutes normal fetal movements and advice about reporting concerns of a reduction in fetal movements to a health care provider; and 2) information for clinici...
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# **Discussion: Implementation and future research** Improving the consistency and standard of information provided to pregnant women on fetal movements and on the significance of reporting decreased fetal movements is likely to reduce anxiety associated with DFM and, more importantly, may lead to timely intervention ...
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# **Discussion: Implementation and future research** Two large stepped-wedge, cluster-randomized trials currently underway will likely impact guidelines to support women experiencing a decrease in fetal movement. These trials in Scotland (AFFIRM study) and Australia/New Zealand (My Baby's Movements) hypothesise to red...
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**Appendix A. Risk factors for stillbirth in high-income country settings** | Factor | aOR (95% CI) | PAR* (%) | |-------------------------------------------------------------|-----------------|----------| | Demographic and fertility | | | | Maternal age¥ | | | | 35-39 years | 1.5 (1.2-1.7) | - | | 40-44 years | 1.8 (...
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**Appendix A. Risk factors for stillbirth in high-income country settings** | Factor | aOR (95% CI) | PAR* (%) | |-------------------------------------------------------------|-----------------|----------| | Non-communicable disease and obesity | | | | BMI (kg/m2 € ) | | | | 25-30 | 1.2 (1.1-1.4) | - | | >30 | 1.6 (1....
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**Appendix A. Risk factors for stillbirth in high-income country settings** | Factor | aOR (95% CI) | PAR* (%) | |-------------------------------------------------------------|-----------------|----------| | Pre-existing hypertension | 2.6 (2.1-3.1) | 5-10 | | Pre-eclampsia | 1.6 (1.1-2.2) | 3.1 | | Eclampsia | 2.2 (1...
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**Appendix A. Risk factors for stillbirth in high-income country settings** | Factor | aOR (95% CI) | PAR* (%) | |-------------------------------------------------------------|-----------------|----------| | Rhesus disease | 2.6 (2.0-3.2) ± | 0.6± | | Lifestyle factors | | | | Smoking | 1.4 (1.3-1.5) | 4-7 | | Illicit...
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**Appendix A. Risk factors for stillbirth in high-income country settings** **Notes**:High-income countries for aOR and PAR calculations include Australia, Canada, USA, UK and the Netherlands. aOR=adjusted odds ratio (95% confidence interval). \*PAR=population attributable risk (the proportion of cases that would not ...
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**Appendix A. Risk factors for stillbirth in high-income country settings** tillbirths: rates, risk factors and potential for progress towards 2030. Lancet 2016; 387: 587–603. Lamont K, Scott NW, Jones GT, Bhattacharya S. Risk of recurrent stillbirth: systematic review and metaanalysis. *BMJ* 2015; 350: h3080.
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# **Appendix B. Methods for guideline development** - Review the scope of the guideline for clinical relevance, to identify questions, target groups and health outcomes relevant to the guideline; - Assess existing guidelines; - Conduct a systematic graded review of the literature, to identify and evaluate the evidence...
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# **Appendix B. Methods for guideline development** - Disseminate and implement the guideline; - Monitor, evaluate and maintain the guideline - Identify gaps in current information for the ongoing refinement of the guideline. In 2015-16, an update was undertaken to review the literature, evidence and recommendations....
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#### **Guiding research questions** The following questions were raised by the working party and formed the basis of the search strategy: - What is the definition of DFM? - Within what time frame should a women report concerns of DFM? - What is the role of formal fetal movement monitoring in reducing adverse pregnanc...
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MamaRetrieval — v0.2.0

A retrieval evaluation benchmark for medical RAG systems serving midwives and doctors. 3,185 clinical queries on midwifery / OBGYN topics, evaluated against the top-20 results of 6 retrievers, with per (query, chunk) pair labels graded by an LLM judge under a four-dimension rubric.

This release is the Tier 3 split (top-20 union of 6 retrievers, 230,964 labelled (q, c) pairs). It extends the v0.1.0 Tier 2 release (top-3 union, 36,418 pairs) — Tier 2's pairs are a strict subset of v0.2.0's, recoverable from rankings with rank <= 3.

Quick start

from datasets import load_dataset

queries   = load_dataset("nmrenyi/mamaretrieval", "queries",   split="test")
rankings  = load_dataset("nmrenyi/mamaretrieval", "rankings",  split="test")
judgments = load_dataset("nmrenyi/mamaretrieval", "judgments", split="test")
chunks    = load_dataset("nmrenyi/mamaretrieval", "chunks",    split="test")

# Optional — the same judgments + the judge's per-row reasoning trace (~770 MB)
judgments_full = load_dataset("nmrenyi/mamaretrieval",
                              "judgments_with_reasoning", split="test")

Configs

Config Rows Columns What it is
queries 3,185 query_id, query_text, seed_chunk_id The benchmark queries, each generated by an LLM from a single chunk of the corpus.
rankings 382,200 query_id, retriever, rank, chunk_id, score For every query × retriever combination, the top-20 chunk_ids with the retriever's similarity score. 6 retrievers × 3,185 queries × 20 = 382,200.
judgments 230,964 query_id, chunk_id, d1_topic, d2_meaningful, d3_actionable, d4_density, score One label per unique (query, chunk) pair in the pooled top-20 union. score = d1 × (d2 + d3 + d4) ∈ [0..6].
judgments_with_reasoning 230,964 (same as judgments) + thinking The same labels with the judge model's reasoning trace per row. Ships in audit/ because it's ~770 MB and not needed to use the benchmark.
chunks 41,298 chunk_id, text The chunk text for every chunk_id referenced by queries.seed_chunk_id or any retriever's top-20 result. Drawn from the producer corpus (see Provenance).

Schema notes

  • chunk_id is the 16-character hexadecimal identifier from the producer corpus. Every chunk_id that appears in rankings, judgments, judgments_with_reasoning, or queries.seed_chunk_id is guaranteed to be resolvable in chunks.
  • score in judgments is computed downstream from the four dimensions via score = d1 × (d2 + d3 + d4). The judge emits only d1..d4.
  • seed_chunk_id records which chunk an LLM was given when it synthesised the query. It's provenance, not a gold label — seed chunks may not appear in any retriever's top-20, and when they do they are not always the highest-rated chunk for that query.

Rubric

The judge scores each (query, chunk) pair on four dimensions:

  • D1 — Topic (bool): does the chunk address the same clinical problem as the query (same condition, intervention, and clinical-timing context)? If D1 = false, D2 = D3 = D4 = 0 automatically.
  • D2 — Meaningful clinical content (0–2): how rich is the chunk's clinical content, independent of whether it specifically answers the query?
  • D3 — Actionable guidance (0–2): how specific is the actionable guidance — vague advice (0), general direction (1), exact doses/thresholds/steps (2)?
  • D4 — Density (0–2): what fraction of the chunk is directly useful for answering this specific query?

score = d1 × (d2 + d3 + d4) ∈ [0..6].

The full prompt — including four worked examples that anchor the calibration — is shipped verbatim at audit/judge_relevance_prompt.txt. Its prompt_hash is recorded in manifest.json.

Retrievers

name model
bm25 BM25 (lexical baseline)
medcpt ncbi/MedCPT (Query + Article encoders)
octen Octen/Octen-Embedding-8B
voyage voyage-4-large
lateon lightonai/GTE-ModernColBERT-v1 (late-interaction ColBERT)
gecko gecko-1024-quant-v0.2.0 (on-device TFLite, deployed retriever)

All retrievers were run on the producer corpus (see Provenance) and their top-20 results are exposed here. v0.1.0 exposed only the top-3; v0.2.0 ships the full top-20 of each, with judgments covering every chunk in the union pool.

How the dataset was made

  1. Query generation. For each clinically-relevant chunk in the producer corpus, an LLM (Qwen/Qwen3.6-27B-FP8) was prompted to produce one ≤20-word clinical question the chunk could answer. Chunks judged non-clinical (e.g. course outlines, references, learning objectives) were skipped. The full prompt is shipped at audit/query_generation_prompt.txt.
  2. Retrieval. Each query was run against the producer corpus by every retriever. Top-20 candidates per retriever were stored.
  3. Pooling. For each query, the union of every retriever's top-20 was deduped (~72 unique chunks per query on average at this scale).
  4. Judging. Every (query, chunk) pair in the pool was scored by Qwen/Qwen3.5-397B-A17B-FP8 against the four-dimension rubric. The judge's reasoning was captured separately and is shipped in judgments_with_reasoning.

Validation: the judge model was calibrated against Claude Opus 4.7 reference labels on a 62-pair pilot, with 95% threshold agreement at score ≥ 3 and 85% at score ≥ 5.

Provenance

  • Producer corpus: rag-bundle-v0.2.0, produced at commit a1abe003 of nmrenyi/mamai-medical-guidelines. The 63,650-chunk corpus the retrievers were run against. Built from a mix of WHO guidelines, Tanzania / Zanzibar MOH documents, and a small set of midwifery references.
  • Versioning: v0.1.0 = Tier 2 (top-3 union, 36,418 pairs). v0.2.0 (this release) = Tier 3 (top-20 union, 230,964 pairs). Tier-2 pairs are a strict subset of Tier-3 pairs; reproducing v0.1.0 from v0.2.0 amounts to filtering rankings by rank <= 3 and inner-joining judgments.
  • Audit trail: manifest.json pins exact judge and generator model IDs, prompt hashes, and schema versions.

License — Research use only

This dataset is released for non-commercial academic research and retrieval-evaluation benchmarking only. By downloading or using it, you agree to all of the following:

Permitted

  • Academic research, including publication of aggregate metrics, qualitative analysis, ablations, and methodology comparisons.
  • Use as an evaluation benchmark for retrieval systems.
  • Re-running the rubric or running new judges against the included (query, chunk) pairs for methodology research.

Not permitted without explicit written permission

  • Any commercial use, including evaluation as part of internal product decisions at for-profit organisations.
  • Use of the chunk text as training data for any model — generative, embedding, retrieval, or otherwise.
  • Redistribution of the chunk text, in whole or in part, outside the form shipped here (i.e. do not extract chunks.parquet, repackage, mirror, or re-host the chunk content).
  • Production deployment of any system whose retrieval or judging behaviour has been tuned on this data.
  • Clinical use of the chunk text. None of the chunk content has been reviewed for clinical accuracy in the form presented here; do not surface it to patients or clinicians.

Full terms — including upstream-licensing constraints, attribution, and warranty disclaimers — are in LICENSE.

Citation

Ren, Yi. MamaRetrieval v0.2.0. 2026. https://huggingface.co/datasets/nmrenyi/mamaretrieval

Limitations

  • Scope: midwifery / OBGYN / neonatal care, framed for guidelines deployed in Zanzibar. Performance numbers do not transfer cleanly to general medical retrieval.
  • Depth-20 ceiling: ~6% of queries have no score ≥ 5 chunk in the 6-retriever top-20 union, even from the strongest retriever. This is an inherent retrieval ceiling for the producer corpus + retriever set, not a per-retriever failure. The Tier 3 labels make this measurable directly (196 / 3185 queries fall outside the strict-relevance pool).
  • Single relevance judge: every (query, chunk) relevance label in this dataset is produced by one LLM (Qwen/Qwen3.5-397B-A17B-FP8) under the four-dimension rubric. That judge was calibrated against Claude Opus 4.7 on a 62-pair pilot — 95% threshold agreement at score ≥ 3, 85% at ≥ 5 — but that's a small LLM-vs-LLM sanity check, not a human-annotated gold standard. Practical consequences: retriever-vs-retriever rankings tend to be stable across reasonable relevance judges, but absolute score distributions and per-row labels will shift if you re-grade the same (query, chunk) pairs with a different judge. Treat each label as one judge's calibrated opinion, not ground truth.
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