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

Meena Bhatia; Vaia Mitsi; Lisa Court; Premila Thampi; Mohamed El-Nasharty; Saeed Hesham; Wendy Randall; Rachel Davies; Lawrence Impey

doi:10.1111/aogs.13671

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

Acta Obstet Gynecol Scand. 2019 Nov;98(11):1450-1454. doi: 10.1111/aogs.13671. Epub 2019 Jul 11.

Authors

Meena Bhatia¹, Vaia Mitsi², Lisa Court³, Premila Thampi⁴, Mohamed El-Nasharty^{5

6}, Saeed Hesham⁶, Wendy Randall¹, Rachel Davies⁷, Lawrence Impey¹

Affiliations

¹ Oxford Fetal Medicine Unit, Women's Center, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
² Department of Obstetrics and Gynecology, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham, Slough, UK.
³ Department of Obstetrics and Gynecology, Royal Berkshire NHS Foundation Trust, Reading, UK.
⁴ Department of Obstetrics and Gynecology, Milton Keynes University NHS Foundation Trust, Milton Keynes, UK.
⁵ Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.
⁶ Department of Obstetrics and Gynecology, Great Western Hospital NHS Foundation Trust, Swindon, UK.
⁷ Oxford Academic Health Science Network, Oxford, UK.

PMID: 31148156
DOI: 10.1111/aogs.13671

Abstract

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.

Keywords: adverse outcomes; cardiotocograph; pregnancy risk; reduced fetal movements; stillbirth.

MeSH terms

Adult
Cardiotocography / methods
Cohort Studies
Female
Fetal Growth Retardation / diagnostic imaging*
Fetal Movement / physiology*
Gestational Age
Humans
Infant, Small for Gestational Age*
Pregnancy
Pregnancy Outcome*
Retrospective Studies
Risk Assessment
Stillbirth*
Ultrasonography, Prenatal*
United Kingdom