Reduced fetal movements and cerebroplacental ratio: evidence for worsening fetal hypoxemia

Binder, Julia; Monaghan, Caitriona; Thilaganathan, B.; Morales‐Roselló, José; Khalil, Asma

doi:10.1002/uog.18830

Cited by 22 publications

(26 citation statements)

References 27 publications

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“…Our finding that SGA is not more common in women with recurrent RFM is at odds with O'Sullivan et al, and with Scala et al, who found a far higher (44.2% vs 9.8%) proportion of SGA (unstated reference chart) babies in the multiple episodes group . Despite this, using an overlapping but larger cohort, Binder et al demonstrated no difference in birthweight centile or incidence of SGA between pregnancies with single or multiple episodes . They did record however, a small increase (5.9%‐7.8%) in a low (<5th centile) cerebroplacental ratio and a decrease in cerebroplacental ratio multiples of the median in women with multiple episodes.…”

Section: Discussioncontrasting

confidence: 50%

“…The incidence of RFM is relatively high; particularly, the proportion of women who present more than once (46%), which is higher than what has been previously reported . It is possible that this is in part a result of a current and ongoing national awareness campaign in the UK…”

Section: Discussionmentioning

confidence: 79%

“…Perception of fetal movements is affected by multiple influences; equally, the perception of RFM is very common . These, together with the very modest risks of markers of placental dysfunction in women with repeated episodes, and the contradictory data on birthweight, suggest that recurrent RFM is likely to be a poor discriminator of pregnancy risk. This is pertinent when multiple established risks factors, such as poor obstetric history, hypertension, SGA, abnormal uterine artery Doppler or cerebroplacental ratio already exist.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, RFM is a common symptom in pregnancy and reason for access to emergency care: approximately 8%‐17% will present, and the incidence of fetal demise or compromise at presentation is low . There is, however, the capacity to do harm, either by causing increased maternal anxiety or through obstetric intervention, by using resources, or by iatrogenic preterm or early term birth.…”

Section: Introductionmentioning

confidence: 99%

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The outcomes of pregnancies with reduced fetal movements: A retrospective cohort study

Bhatia

Mitsi

Court

et al. 2019

Acta Obstet Gynecol Scand

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Introduction The objective of this study was to examine the outcomes and interventions in pregnant women presenting with a perception of reduced fetal movements (RFM), and to determine if repeated episodes of RFM increase the risk of adverse outcomes. Material and methods This was a retrospective cohort study conducted in six NHS hospitals within the Thames Valley network region, UK and one neighboring hospital, an area with approximately 31 000 births annually. All women with a primary presentation of perceived RFM after 24 completed weeks of gestation during the month of October 2016 were included in the study. Prospective records in all units were examined and individual case‐notes were reviewed. Pregnancy and neonatal outcomes and their relation with recurrent presentations with RFM were examined using relative risks with 95% CI. The main outcome measures are described. Neonatal outcomes measured were perinatal mortality, neonatal unit admission, abnormal cardiotocography at presentation, a composite severe morbidity outcome of Apgar <7 at 5 minutes or arterial pH <7.0 or encephalopathy, and birthweight. Pregnancy outcomes measured were induction of labor, cesarean section, admission and ultrasound usage rates. Results In all, 591 women presented with RFM during the month; using annual hospital birth figures, the incidence of RFM was estimated at 22.6% (range 14.9%‐32.5%). More than 1 presentation of RFM occurred in 273 (46.2%). All 3 deaths (0.5%) were at the first presentation. More than 1 presentation was associated with higher induction rates (56.0% vs 31.9%), but no increase in any adverse outcomes including small‐for‐gestational‐age. Conclusions Reduced fetal movements, and recurrent episodes, are common, and lead to considerable resource usage and obstetric intervention. We found no evidence to suggest that recurrent episodes increase pregnancy risk.

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Section: Discussioncontrasting

confidence: 50%

Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The outcomes of pregnancies with reduced fetal movements: A retrospective cohort study

Bhatia

Mitsi

Court

et al. 2019

Acta Obstet Gynecol Scand

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“…One case‐control study, Warrander et al , reported that median (range) BMI was not significantly different between women who presented with DFM and gave birth within 7 days ( n = 36) and women without DFM ( n = 36) (24.4, 18.1–45.6 kg/m 2 vs. 24.6, 17.8–41.6 kg/m 2 , p = 0.88) . Another case‐control study, Binder et al, reported median [interquartile range (IQR)] BMI of 24.6 (IQR 21.9–28.3) kg/m 2 in DFM cases ( n = 4500), which was not significantly different ( p = 0.40) from the median (IQR) BMI of 24.5 (IQR, 22.0–28.78) kg/m 2 in controls ( n = 1527) . In contrast, Pagani et al , reported that women presenting with DFM ( n = 742) had significantly higher median (IQR) BMI than control women ( n = 16 907, 24.2, IQR 21.8–28.3 kg/m 2 vs. 23.5, IQR 21.2–26.7 kg/m 2 , p ≤ 0.001).…”

Section: Resultsmentioning

confidence: 99%

Understanding the associations and significance of fetal movements in overweight or obese pregnant women: a systematic review

Bradford

Thompson

Heazell

et al. 2017

Acta Obstet Gynecol Scand

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Longitudinal change in cerebroplacental ratio in small‐for‐gestational‐age fetuses and risk of stillbirth

Kalafat

Öztürk

Sivanathan

et al. 2019

Ultrasound in Obstet & Gyne

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Objective To investigate whether assessment of longitudinal change in Doppler variables in small‐for‐gestational‐age (SGA) fetuses improves the prediction of those at risk of stillbirth. Methods This was a longitudinal study of two cohorts of singleton pregnancies, which included SGA and appropriate‐for‐gestational‐age (AGA) fetuses, respectively. The inclusion criteria for the SGA cohort were singleton pregnancy at ≥ 20 weeks' gestation, classified as SGA (estimated fetal weight < 10th centile). The AGA cohort consisted of singleton pregnancies deemed at high risk of being SGA, which were followed up longitudinally but remained AGA. Fetal middle cerebral artery (MCA) pulsatility index (PI) and umbilical artery (UA)‐PI were measured longitudinally and cerebroplacental ratio (CPR) was calculated, and values were converted to multiples of the median. The last two measurements prior to delivery were included in the analysis. Longitudinal models for Doppler variables were developed using linear‐mixed models and their accuracy in the prediction of stillbirth was tested using generalized linear models. A Bayesian framework was employed to compare the accuracy of longitudinal and standard (last‐scan measurement) models. Results In total, 1549 AGA and 941 SGA pregnancies were included in the analysis. There were 30 (3.2%) and no stillbirth cases in the SGA and AGA groups, respectively. Change in MCA‐PI, UA‐PI and CPR with advancing gestation was significantly different between liveborn AGA and SGA fetuses, with a less pronounced difference with advancing gestation. Using the last measurement, the best models for the prediction of stillbirth in SGA pregnancies were those based on CPR (accuracy, 75.0%; 95% CI, 72.6–77.2%) and UA‐PI (accuracy, 71.0%; 95% CI, 68.6–73.4%). The posterior probability of the standard CPR model having a higher accuracy compared with the UA‐PI model was 97.2% (magnitude of change (MC), 3.9%; 95% credible interval (CrI), 0.5–7.3%). The accuracies of the standard, compared with the longitudinal, models for UA‐PI (71.0% vs 72.8%), MCA‐PI (64.6% vs 63.8%) and CPR (75.0% vs 74.9%) in the prediction of stillbirth were not significantly different. The posterior probabilities for improvement in accuracy using longitudinal, compared with standard, assessment were 50.1% (MC, < 0.1%; 95% CrI, −3.3 to 3.3%), 35.2% (MC, −0.1%; 95% CrI, −4.5 to 2.8%) and 82.2% (MC, 1.9%; 95% CrI, −1.5 to 5.3%) for CPR, MCA‐PI and UA‐PI models, respectively. Therefore, change in Doppler parameters did not improve the accuracy of the prediction of stillbirth, compared with that of the last‐scan measurement. Conclusion Longitudinal assessment of Doppler parameters was not useful in improving the detection of stillbirth in SGA pregnancies, as compared with a single‐point assessment. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

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Reduced fetal movements and cerebroplacental ratio: evidence for worsening fetal hypoxemia

Cited by 22 publications

References 27 publications

The outcomes of pregnancies with reduced fetal movements: A retrospective cohort study

The outcomes of pregnancies with reduced fetal movements: A retrospective cohort study

Understanding the associations and significance of fetal movements in overweight or obese pregnant women: a systematic review

Longitudinal change in cerebroplacental ratio in small‐for‐gestational‐age fetuses and risk of stillbirth

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