Obstetric and neonatal outcome among women presenting with reduced fetal movements in third trimester

Abstract

INTRODUCTIONMaternal perception of fetal movements is a selfscreening method for assessing fetal well-being. Studies have shown that reduced fetal movement (RFM) is a risk factor for several adverse perinatal outcomes. About a quarter of women presenting with RFM have pregnancies complicated by fetal growth restriction, preterm delivery, fetal distress or stillbirth. A growing number of studies have confirmed a correlation between episodes of RFM and stillbirth.1 RFM has been shown to occur in up to 15% of pregnancies.2 Women who have a stillbirth note a reduction in fetal movement prior to diagnosis in up to 55%.3 Inadequate clinician response to the complaint of RFM is an important contributory factor to stillbirth. 4 Fetal movement counting may allow the clinician to make appropriate interventions in right time to improve ABSTRACT Background: Reduced maternal perception of fetal movements allows early identification, timely evaluation and intervention for fetuses at risk of adverse outcome. The primary objective of this study was to assess the pregnancy characteristics and outcomes of pregnant women presenting to hospital with reduced fetal movements (RFM). Methods: Prospective observational study, recruiting all women with singleton pregnancy at or beyond 28 weeks of gestation presenting with a subjective perception of RFM from April 2015 to December 2016. Maternal characteristics, antenatal risk factors, management pathways and perinatal outcome studied. Results: 47% belonged to high risk pregnancy. Among high risk women, although only 39% showed poor BPP at the first presentation, 58% were delivered irrespective of their gestational age, out of which 32.75% had poor neonatal outcome. Among low risk who had >2 episodes of RFM, 50% had poor neonatal outcome. 7% among high risk pregnancies and 18% among low risk, presented with RFM within 48 hours following steroid prophylaxis.24% of high risk women showed liquor volume abnormalities as compared to low risk (6.3%). Conclusions: Significant proportion of those with RFM belonged to high risk pregnancy. Among high risk group, there were high rates of stillbirth and poor BPP at the time of admission when compared to low risk group. Due to early approach to the hospital and timely intervention, significant women with abnormal BPP had good perinatal outcome. All those fetuses who were delivered on first episode of RFM in low risk group did not show evidence of compromise at birth, probably indicating unnecessary delivery. More than 2 episodes of RFM even among low risk group seems significant as good number of fetuses were compromised at birth. Steroids prophylaxis for the fetal lung maturity causes transient changes in BPP, hence unnecessary delivery should be avoided especially those among low risk pregnancy.

Neonatal Near Miss and Its Associated Factors at Injibara General Hospital, Awi Zone, Northwest Ethiopia, 2019

“…Similarly, different studies revealed that reduced fetal movement was associated with poor prenatal outcomes of those with preterm birth, perinatal birth injury, low birth weight, low APGAR score, increase rate of cesarean section, and neonatal and fetal deaths. 22,23 Obstetrics complications during labor-delivery were strongly associated with NNM in our study. Women with obstructed labor/ cephalo-pelvic disproportion showed four-times increased odds of NNM, as compared to their counterparts.…”

Pregnancy outcomes in women presenting with single versus multiple episodes of reduced fetal movements: A prospective observational study

“…Similarly in a study by Poojari et al on 210 pregnant women, 75% were primiparous. 4 Similar findings were also observed in a study on maternal characteristics and outcome with reduced fetal movements by Holm Tveit et al in 2009, who suggested that maternal inexperience in these women can be an added risk factor for their pregnancies and better tools are needed to increase their awareness. 5 We also compared the pregnancy outcomes of parturient presenting with single versus multiple episodes of reduced fetal movement.…”

Correlation study between increased fetal movement during the third trimester and neonatal outcome

“…These studies have confirmed that fetal abnormalities can be detected early by monitoring fetal movement, which are a common complaint by pregnant women during the third trimester. Furthermore, these studies reported that reduced fetal movement is a clear maternal symptom associated with stillbirth and poor prognosis of neonates [5–8], possibly through placental dysfunction [9].…”