Evaluation of Pregnancy Outcomes Among Women With Decreased Fetal Movements

Abstract

IMPORTANCE Stillbirth is a devastating pregnancy outcome with far-reaching economic and psychosocial consequences, but despite significant investment, a screening tool for identifying those fetuses at risk for stillbirth remains elusive. Maternal reporting of decreased fetal movements (DFM) has been found to be associated with stillbirth and other adverse perinatal outcomes. OBJECTIVETo examine pregnancy outcomes of women presenting with DFM in the third trimester at a tertiary Australian center with a clear clinical management algorithm. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data on all births meeting the inclusion criteria from 2009 through 2019 at Mater Mothers' Hospital in Brisbane, Australia. This is a tertiary center and Australia's largest maternity hospital. All singleton births without a known congenital anomaly after 28 weeks' gestation were included. Among 203 071 potential participants identified from the hospital database, 101 597 individuals met the eligibility criteria. Data analysis was performed from May through September 2020. EXPOSURE Presentation to hospital with DFM after 28 weeks gestation. MAIN OUTCOMES AND MEASURES The primary outcome of this study was the incidence of stillbirth. Multivariate analysis was undertaken to determine the association between DFM and stillbirth, obstetric intervention, and other adverse outcomes, including being born small for gestational age (SGA) and a composite adverse perinatal outcome (at least 1 of the following: neonatal intensive care unit admission, severe acidosis [ie, umbilical artery pH <7.0 or base excess −12.0 mmol/L or less], 5-minute Apgar score <4, or stillbirth or neonatal death). The hypothesis being tested was formulated prior to data collection. RESULTS Among 101 597 women with pregnancies that met the inclusion criteria, 8821 (8.7%) presented at least once with DFM and 92 776 women (91.3%) did not present with DFM (ie, the control population). Women presenting with DFM, compared with those presenting without DFM, were younger (mean [SD] age, 30.4 [5.4] years vs 31.5 [5.2] years; P < .001), more likely to be nulliparous (4845 women [54.9%] vs 42 210 women [45.5%]; P < .001) and have a previous stillbirth (189 women [2.1%] vs 1156 women [1.2%]; P < .001), and less likely to have a previous cesarean delivery (1199 women [13.6%] vs 17 444 women [18.8%]; P < .001). During the study period, the stillbirth rate was 2.0 per 1000 births after 28 weeks' gestation. Presenting with DFM was not associated with higher odds of stillbirth (9 women [0.1%] vs 185 women [0.

My Baby’s Movements: a stepped‐wedge cluster‐randomised controlled trial of a fetal movement awareness intervention to reduce stillbirths

“…Additionally, balancing how to inform women of DFM without raising concern is challenging and requires further attention. 32 A decrease in fetal movement is only mildly to moderately associated with stillbirth and performs poorly as a screening tool, 10,33 with most women experiencing DFM having a healthy baby. Early planned birth to avoid stillbirth for women with DFM needs to be carefully weighed against the risk of adverse newborn outcome.…”

Revisiting Decreased Fetal Movements After 28 Weeks Gestation—An Important Obstetric Symptom and Surrogate Associated With Placental Insufficiency

“…The authors argue that in these cases, DFM is a symptom of fetal demise, a fait accompli; hence, their inclusion would overemphasize any association with stillbirths, which could perhaps explain the contrarian results found in earlier studies investigating DFM and stillbirth. 2 The most important finding from this paper is the association of DFM with the birth of an infant who is small for their gestational age, with the symptom of DFM being a reflection of the fetal response to a hypoxic milieu generated by placental dysfunction. The inclusion of a considered ultrasonographic fetal growth and well-being assessment into their clinical algorithm after 2016 reflects this thinking and indeed should lead clinicians to review their existing protocols managing DFM to consider including this additional assessment.…”

“…Moreover, women with 2 or more recurrent presentations of DFM had increased odds of stillbirth. 2 Of note is the observation that the absolute number of women reporting DFM increased steadily throughout the 11 years of the study period. Interestingly, there was no corresponding increased rate of stillbirth.…”

“…The study by Turner et al is a welcome and interesting addition shedding new light on an already crowded field populated by many studies of low grading of evidence addressing DFM. A retrospective analysis of more than 100 000 women in Australia’s largest tertiary-level maternity hospital spanning 11 years, the study by Turner et al showed that DFM, when managed according to a clear management algorithm, was not associated with an increased risk of stillbirth.…”

Pelatihan Self-Assessment Dan Self-Management Untuk Pekerja Migram Indonedia Di Taiwan

“…Pergerakan janin mulai dapat dirasakan ibu saat usia kehamilan 16 minggu keatas. Penelitian yang dilakukan oleh Turner et al, (2021)) menunjukkan bahwa pergerakan janin merupakan salah satu tanda yang berkaitan dengan peningkatan risiko pada janin. Ibu yang memiliki pengetahuan baik tentang perubahan pergerakan janin mampu mendapatkan penanganan dini sehingga mampu menurunkan angka kematian janin.…”