Predicting poor perinatal outcome in women who present with decreased fetal movements

Abstract

Maternal perception of decreased fetal movements (DFM) is associated with increased incidence of stillbirth and intrauterine growth restriction. We hypothesised that clinical assessment of women perceiving DFM may identify patients at highest risk of poor perinatal outcome. This was a retrospective study of 203 patients presenting to the obstetric triage service with DFM. Information on obstetric and past medical history, the current presentation with DFM and the outcome of pregnancy was collected. Using multivariate analysis, odds ratios (OR) and 95% confidence intervals (CI) were calculated for poor pregnancy outcome defined as stillbirth, small for gestational age or pre-term delivery. The rate of stillbirth was increased in women with DFM (OR 2.9). Some 26.6% of women perceiving DFM had a poor perinatal outcome. Women with relevant past obstetric history (OR 2.11), two or more presentations of DFM (OR 1.92), or who measured small-for-dates (OR 19.53) were at increased risk of poor pregnancy outcome. These preliminary data suggest that some features of clinical assessment can identify patients at increased risk of poor perinatal outcome after presentation with DFM. Such patients may be prioritised for detailed assessment of fetal growth and wellbeing.

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

“…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%.…”

Maternal Perception and Antenatal Advice regarding Fetal Movements in Al-Gharbyia Governorate, Egypt

“…It reduces the risk of stillbirth, fetal growth restriction, fetal distress and perinatal mortality. Furthermore, the maternal-fetal attachment is increased by fetal movements' perception (11,20,21) . Health care providers have long acknowledged the importance of maternally perceived fetal movements, but continue to DOI: 10.9790/1959-060207107119 www.iosrjournals.org 117 | Page under investigate the maternal perception of fetal activity to date (22,23) .…”

“…While, excessive movements provide reassurance of fetal well-being and oxygenation (16,29,30) . On the other hand, several researchers indicated that women who perceive a reduction in fetal movements will have a normal outcome to their pregnancy (4,11,31) . Regarding knowledge of fetal movement, the present study revealed that the majority of the studied women expressed that it is important to feel the fetal movements, and three-quarters of them reasoned that this is an indication that the baby is alive.…”

“…The daily fetal movements counting may increase the mother's awareness to recognize the warning signs that put the fetus in danger, and then the suitable time for proper intervention (9,10) . Decreased fetal movement (DFM) or an absence of fetal movements for a period of time are considered as an indicator of a fetus at risk for fetal compromise and have been associated with an increased risk of intrauterine fetal death and stillbirth (11,12,13) . Stillbirth continues to be a prevalent health issue for families, midwives, and other healthcare providers with 1:130 women of 20 weeks gestation or more having a stillborn baby (14) .…”

Reduced Fetal Movements

“…If the perception of reduced FM persists, consideration should be given to other causes such as fetal structural anomalies (4.3%), anaemia or feto-maternal haemorrhage. There is little evidence how to manage these pregnancies, however women who present on two or more occasions with reduced FM are at increased risk of poor perinatal outcome compared with those who attend only once (OR 1.92; 95% CI 1.21 -2.02) (O'Sullivan et al, 2009). A practical approach would be to perform ultrasound assessment to rule out SGA, structural anomalies and oligo-or polyhydramnios and invite the woman for daily CTGs until mother and clinician are reassured.…”