Obstetric outcome in women who present with a reduction in fetal movements in the third trimester of pregnancy

Abstract

A complaint of decreased fetal movements is a common indication for the assessment of fetal well being. The aim of this study was to review the outcome of a group of women whose primary indication for referral was decreased fetal movements. Over a 20 month period, 435 patients were seen in the fetal assessment unit of an inner London teaching hospital, following a primary complaint of reduced fetal movements. Investigations included: the fetal abdominal circumference (AC), amniotic fluid volume (AFV), the umbilical artery pulsatility index (UAPI) derived from Doppler ultrasound waveforms and a computerised analysis of fetal heart rate (FHR) recordings or cardiotocograph (CTG). Outcome measures were: gestational age at delivery, Apgar score < 7 at 5 minutes, admission to the Special Care Baby Unit (SCBU), the need for delivery by an emergency cesarean section for fetal compromise (CSFC), and any perinatal deaths. A comparison of actual versus expected outcome for women with decreased fetal movement revealed the following relative risks, with the 95% confidence intervals (CI) in brackets; low 5 minute Apgar score 0.03 vs. 0.05 expected (CI = 0.01, 0.05), SCBU admission, 0.06 vs. 0.07 (0.04, 0.08), and preterm delivery, 0.08 vs. 0.11 (0.05, 0.10). Cesarean sections for fetal compromise, 0.07 vs. 0.053 (0.050-0.096). The addition of FHR monitoring to standard ultrasound assessment of well being did not appear to confer any added benefit. There were no fetal deaths. The outcome for pregnancies where the mother presents with decreased fetal movements in the third trimester is comparable with the outcome for the general population.

Perception of obstetric danger signs among women living on the coastline of the Atlantic Ocean in rural Lagos, Nigeria

“…Nearly 50% of late-pregnancy intra-uterine fetal deaths have no associated risk factors, though fetal demise may however be heralded by decreased fetal movement followed by cessation of movement at least 12 h before death (Institute for Clinical Systems Improvement, 2008). In view of this, Harrington et al (1998) contend that maternal perception of decreased fetal movement is not associated with poor fetal outcome.…”

Maternal characteristics and pregnancy outcomes in women presenting with decreased fetal movements in late pregnancy

“…A common factor in these studies is that the mother is lying down and focusing on fetal activity, which constitutes the only situation in which maternal perception and objective measures of FM are strongly correlated with actual fetal activity. In other settings, both the actual frequency of movements as well as the mother's ability to perceive them are influenced by factors such as activity and exercise (29), anxiety (30), administration of corticosteroids (betamethasone and dexamethasone) (6;31-33), blood sugar (34), intrauterine growth restriction (19;35), maternal position (36), major fetal malformations (37;38), obesity (39), placenta localization (16), smoking (40), sedating drugs (6), stress (41), and sound and vibroacoustic stimulation (42;43). Parity has not been found to affect maternal perception of FM in the third trimester (16).…”

Management of subsequent pregnancy after an unexplained stillbirth

“…69,70 As many as 15% of women will present with reported reduction in fetal movements during a pregnancy, making this a very common symptom. 71 Maternal perception is highly variable with ultrasound studies showing that only a small proportion of fetal movements are actually felt by the woman. 72 The negative conclusions of trials of 'kick charts' have been challenged, 73 but as yet there is no convincing evidence that use of formal fetal movement charting improves pregnancy outcomes.…”