Promoting Awareness Fetal Movements to Reduce Fetal Mortality Stillbirth, a Stepped Wedge Cluster Randomised Trial.

NCT ID: NCT01777022

Last Updated: 2018-02-08

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

430830 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-01-01

Study Completion Date

2017-09-30

Brief Summary

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Rates of stillbirth in Scotland are among the highest in resource rich countries. The majority of stillbirths occur in normally formed infants, with (retrospective) evidence of placental insufficiency being the commonest clinical finding. Maternal perception of decreased fetal movements appears to be an early biomarker both of placental insufficiency and subsequent stillbirth.

The study proposed here will test the hypothesis that rates of stillbirth will be reduced by introduction of a package of care consisting of strategies for increasing pregnant women's awareness of the need for prompt reporting of decreased fetal movements, followed by a management plan for identification of placental insufficiency with timely delivery in confirmed cases. The odds of stillbirth fell by 30% after the introduction of a similar package of care in Norway but the efficacy of this intervention (and possible adverse effects and implications for service delivery) have not been tested in a randomized trial.

The investigators plan a stepped wedge cluster design trial, in which hospitals in Scotland and Ireland will be randomized to the timing of introduction of the care package. Outcomes (including the primary outcome of stillbirth) will be derived from Scotland and Ireland's detailed routinely collected maternity data, allowing the investigators to robustly test the hypothesis. A nested qualitative study will examine the acceptability of the intervention to patients and health care providers and identify process issues (barriers to implementation).

Detailed Description

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Conditions

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Decreased Fetal Movements Affecting Care of Mother Pregnancy Stillbirth

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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Current treatment

Current education and management protocols will be followed

Group Type NO_INTERVENTION

No interventions assigned to this group

A package of interventions

A package of interventions consisting of strategies for increasing pregnant women's awareness of the need to report early when they perceive a reduction in fetal movements, followed with a management plan for identification and delivery of the "at risk" fetus in such women, will reduce rates of stillbirth

Group Type OTHER

A package of interventions

Intervention Type OTHER

A package of interventions consisting of strategies for increasing pregnant women's awareness of the need to report early when they perceive a reduction in fetal movements, followed with a management plan for identification and delivery of the "at risk" fetus in such women, will reduce rates of stillbirth

Interventions

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A package of interventions

A package of interventions consisting of strategies for increasing pregnant women's awareness of the need to report early when they perceive a reduction in fetal movements, followed with a management plan for identification and delivery of the "at risk" fetus in such women, will reduce rates of stillbirth

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* The study will include all women delivering at one of the maternity units involved in for the duration of the study.

Exclusion Criteria

* Women delivering in the "washout" period in each unit.
Minimum Eligible Age

16 Years

Maximum Eligible Age

60 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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NHS Lothian

OTHER_GOV

Sponsor Role collaborator

University of Edinburgh

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jane E Norman, MD

Role: STUDY_CHAIR

University of Edinburgh

Locations

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National Maternity Hospital

Dublin, , Ireland

Site Status

Rotunda Hospital

Dublin, , Ireland

Site Status

Stepping Hill Hospital

Stockport, Cheshire, United Kingdom

Site Status

Royal Gwent Hospital

Newport, Gwent, United Kingdom

Site Status

Saint Mary's hospital

Manchester, Lancashire, United Kingdom

Site Status

NHS Lothian

Edinburgh, Lothian, United Kingdom

Site Status

Birmingham Women's Hospital

Birmingham, West Midlands, United Kingdom

Site Status

St. Richards Hospital

Chichester, West Sussex, United Kingdom

Site Status

Worthing Hospital

Worthing, West Sussex, United Kingdom

Site Status

Leeds Teaching Hospital NHS Trust

Leeds, Yorkshire, United Kingdom

Site Status

NHS Grampian

Aberdeen, , United Kingdom

Site Status

Neville Hall hospital

Abergavenny, , United Kingdom

Site Status

Betsi Cadwaladr University Heath board (Ysbyty Gwynnedd Hospital)

Bangor, , United Kingdom

Site Status

Royal Jubilee Hospital

Belfast, , United Kingdom

Site Status

Blackpool Victoria Hospital

Blackpool, , United Kingdom

Site Status

NHS Dumfries and Galloway

Dumfries, , United Kingdom

Site Status

NHS Tayside

Dundee, , United Kingdom

Site Status

NHS Greater Glasgow

Glasgow, , United Kingdom

Site Status

NHS Highland

Inverness, , United Kingdom

Site Status

NHS Ayrshire and Arran

Kilmarnock, , United Kingdom

Site Status

NHS Fife

Kirkcaldy, , United Kingdom

Site Status

NHS Forth Valley

Larbert, , United Kingdom

Site Status

St Georges Hospital

London, , United Kingdom

Site Status

NHS Borders

Melrose, , United Kingdom

Site Status

Lancashire Teaching Hospitals NHS Foundation Trust

Preston, , United Kingdom

Site Status

Betsi Cadwaladr University Heath board (Glan Clwyd)

Rhyl, , United Kingdom

Site Status

Royal Albert Edward Infirmary, Wigan

Wigan, , United Kingdom

Site Status

NHS Lanarkshire

Wishaw, , United Kingdom

Site Status

Betsi Cadwaladr University Heath board (Wrexham Maelor)

Wrexham, , United Kingdom

Site Status

Countries

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Ireland United Kingdom

References

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Camacho EM, Whyte S, Stock SJ, Weir CJ, Norman JE, Heazell AEP. Awareness of fetal movements and care package to reduce fetal mortality (AFFIRM): a trial-based and model-based cost-effectiveness analysis from a stepped wedge, cluster-randomised trial. BMC Pregnancy Childbirth. 2022 Mar 22;22(1):235. doi: 10.1186/s12884-022-04563-9.

Reference Type DERIVED
PMID: 35317772 (View on PubMed)

Norman JE, Heazell AEP, Rodriguez A, Weir CJ, Stock SJE, Calderwood CJ, Cunningham Burley S, Froen JF, Geary M, Breathnach F, Hunter A, McAuliffe FM, Higgins MF, Murdoch E, Ross-Davie M, Scott J, Whyte S; AFFIRM investigators. Awareness of fetal movements and care package to reduce fetal mortality (AFFIRM): a stepped wedge, cluster-randomised trial. Lancet. 2018 Nov 3;392(10158):1629-1638. doi: 10.1016/S0140-6736(18)31543-5. Epub 2018 Sep 27.

Reference Type DERIVED
PMID: 30269876 (View on PubMed)

Heazell AEP, Weir CJ, Stock SJE, Calderwood CJ, Burley SC, Froen JF, Geary M, Hunter A, McAuliffe FM, Murdoch E, Rodriguez A, Ross-Davie M, Scott J, Whyte S, Norman JE. Can promoting awareness of fetal movements and focusing interventions reduce fetal mortality? A stepped-wedge cluster randomised trial (AFFIRM). BMJ Open. 2017 Aug 11;7(8):e014813. doi: 10.1136/bmjopen-2016-014813.

Reference Type DERIVED
PMID: 28801392 (View on PubMed)

Provided Documents

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Document Type: Statistical Analysis Plan

View Document

Document Type: Study Protocol

View Document

Other Identifiers

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AFFIRM

Identifier Type: -

Identifier Source: org_study_id

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