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

Bhatia, Meena; Mitsi, Vaia; Court, L.; Thampi, Premila; Elnasharty, Mohamed; Hesham, Saeed; Randall, Wendy; Davies, Rachel; Impey, Lawrence

doi:10.1111/aogs.13671

Cited by 15 publications

(16 citation statements)

References 12 publications

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“…However, our results suggest that risk of stillbirth may be increased among women with 2 or more presentations of DFM compared with women with 1 presentation. Consistent with results from other studies, 14,16,[33][34][35] we found that DFM was associated with higher odds of planned early term birth, IOL, and emergency cesarean delivery for intrapartum fetal compromise and lower odds of vaginal birth. Additionally, we found that women with DFM had higher rates of SGA births.…”

Section: Discussionsupporting

confidence: 91%

Evaluation of Pregnancy Outcomes Among Women With Decreased Fetal Movements

Turner

Flenady

Ellwood

et al. 2021

Obstetrical &Amp; Gynecological Survey

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Decreased fetal movement (DFM) has previously been associated with stillbirth and other adverse perinatal outcomes. Several guidelines highlight the importance of DFM as a sign associated with a risk of stillbirth; however, there is limited national guidance to incorporate this monitoring into stillbirth reduction strategies. The goal of this study was to look at pregnancy outcomes of women with DFM in the third trimester. Secondary outcomes were rates of induction of labor (IOL), planned preterm birth, planned early term birth, vaginal birth, emergency cesarean delivery, infant born small for gestational age (SGA), and severe perinatal outcomes (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 researchers used data on all births meeting inclusion criteria from 2009 to 2019 at Mater Mothers' Hospital in Brisbane, Australia. Inclusion criteria consisted of pregnant women with a singleton fetus without a known congenital anomaly presenting with DFM after 28 weeks 0 days' gestation. Decreased fetal movement management changed over time. During 2009 to 2016, women with DFM received electronic fetal heart rate monitoring. Starting in 2016, these women received fetal heart rate in addition to a blood test to detect fetomaternal hemorrhage and consideration for ultrasonography scan to assess fetal growth and well-being.One hundred one thousand five hundred ninety-seven women were enrolled in the study. Of these women, 8821 (8.7%) had at least 1 episode of DFM, whereas 92,776 women (91.3%) did not. Women presenting with DFM were younger (mean [SD] age, 30.4 [5.4] years vs 31.5 [5.2] years; P < 0.001), more likely to be nulliparous (4845 women [54.9%] vs 42,210 women [45.5%]; P < 0.001), more likely to have had a previous stillbirth (189 women [2.1%] vs 1156 women [1.2%]; P < 0.001), and less likely to have a previous cesarean delivery (1199 women [13.6%] vs 17,444 women [18.8%]; P < 0.001). Decreased fetal movement was not associated with a higher risk of stillbirth (9 women [0.1%] vs 185 women [0.2%]; adjusted odds ratio [aOR], 0.54; 95% confidence interval [CI], 0.23-1.26; P = 0.16). Decreased fetal movement was, however, associated with a higher risk of a fetus being born SGA (aOR, 1.14; 95% CI, 1.03-1.27; P = 0.01) and the composite adverse perinatal outcome (aOR, 1.14; 95% CI, 1.02-1.27; P = 0.02). Decreased fetal movement was also associated with an increased risk of planned early term birth (

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Section: Discussionsupporting

confidence: 91%

Evaluation of Pregnancy Outcomes Among Women With Decreased Fetal Movements

Turner

Flenady

Ellwood

et al. 2021

Obstetrical &Amp; Gynecological Survey

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“…Indeed, primiparous women were 1.4 times more likely to present with RFM compared to multiparous women during COVID. As previous work have repeatedly demonstrated no significant differences in parity with regards to attendances for RFM [ 22 , 23 ], we believe our findings to be true.…”

Section: Discussionsupporting

confidence: 74%

Impact of Covid-19 on attendances for a 1st episode of reduced fetal movements: A retrospective observational study

et al. 2021

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Background Prior studies have demonstrated an increased stillbirth rate. It was suggested that the COVID-19 pandemic may have impacted on attendances for reduced fetal movements. Thus, we sought to ascertain the impact of the pandemic on attendances for reduced fetal movements (RFM) in our unit, ultrasound provision for reduced fetal movements, and the stillbirth rate. Methods This was a single site retrospective cohort study involving all women complaining of a 1st episode of reduced fetal movements between 01/03/2020-30/04/2020 (COVID) to 01/03/2019-30/04/2019 (Pre-COVID). Data were retrieved from computerised hospital records and statistical analyses were performed using GraphPad Prism and SPSS. Results 22% (179/810) of women presented with a 1st episode of reduced fetal movements Pre-COVID compared to 18% (145/803) during COVID (p = 0.047). Primiparous women were significantly over-represented in this population with a 1.4-fold increase in attendances during COVID (67% vs 48%, p = 0.0005). Neither the total stillbirth rate nor the stillbirth rate amongst women who presented with reduced fetal movements changed during COVID. Ultrasound provision was not impacted by COVID with 95% of the scans performed according to local guidelines, compared to Pre-COVID (74%, p = 0.0001). Conclusions There is a significant decrease in 1st attendances for reduced fetal movements during COVID-19 pandemic. Primiparous women were 1.4 times more likely to attend with RFM. Women should be reassured that COVID-19 has not resulted in a decreased provision of care for RFM, and has not impacted on the stillbirth rate.

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“…Similar to our findings, a recent published study from UK showed no association between recurrent RFM episodes and increased adverse neonatal outcome, but an association with higher induction rates. 17 Furthermore, a liberal induction policy starting from 37 weeks for the women with recurrent RFM showed no benefit. 20 Several large projects such as "Each Baby Counts" and the AFFIRM study are trying to improve information and knowledge about IUFD but have not been successful in preventing it.…”

Section: Discussionmentioning

confidence: 99%