Daily structured approach to awareness of fetal movements and pregnancy outcome - a prospective study

Evaluation of the relationship between reduced fetal movement and obstetric-neonatal outcomes and placental pathologies

BACKGROUND

Fetal movements are one of the simple methods that show the baby's well-being. Conditions associated with decreased fetal movements have not been determined, so it is important to analyze their different aspects. This study aimed to evaluate the relationship between reduced fetal movement and obstetric-neonatal outcomes, and placental pathologies.

METHODS

In this prospective controlled study, laboratory results (blood glucose, hemoglobin, thyroid-stimulating hormone [TSH]), a non-stress test (NST), biophysical profile results, obstetric and neonatal outcomes, and placental pathological results of 74 pregnant women at 35 or more gestational weeks (to exclude the effect of prematurity on obstetric and neonatal outcomes) attending the obstetrics clinic between December 26, 2017 and January 30, 2019 with complaints of reduced fetal movement, were compared with 74 healthy pregnant women. Since prematurity and post-maturity may adversely affect obstetric-neonatal and placental pathology results, term pregnancies between 37^0/7-40^6/7 weeks were evaluated separately.

RESULTS

In the group with reduced fetal movement, the biophysical profile was lower than the controls (P=0.013). Among placental pathologies, chorangiosis and hypercoiled cord were significantly higher in the group with reduced fetal movement than controls (P<0.05). Small for gestational age (SGA) and fetal growth restriction (FGR) in this group had these pathologies. Results of women at 37^0/7-40^6/7 weeks were similar except for the additional finding of chorioamnionitis.

CONCLUSIONS

Reduced fetal movement may be associated with the low biophysical profile. In cases where fetal movement decreases, placental chorangiosis and hypercoiled cord seem to be associated with fetal growth restriction.

The effect of formal fetal movement counting on maternal psychological outcomes: A systematic review and meta-analysis

INTRODUCTION

Formally counting fetal movements in pregnancy is one of the oldest methods to assess fetal well-being. Although not routinely recommended in contemporary maternity care, due to a lack of evidence of its effectiveness, formal fetal movement counting is still practiced in many birth settings. Requesting women to formally count their fetal movements in a structured, objective way that can potentially improve maternal subjective outcomes such as worry or concern. The aim of this study was to evaluate the effect of formal fetal movement counting versus no formal counting, on maternal worry, concern or anxiety, and maternal–fetal attachment (MFA). Secondary outcomes were compliance with the intervention (counting method) and hospital admission/attendance for fetal activity concerns.

METHODS

CINAHL, MEDLINE and EMBASE were searched systematically for eligible studies from inception dates to June 2020, supplemented by searches of trial databases, grey literature and the reference lists of included studies. Randomized controlled and quasi-randomized trials were included in the review.

RESULTS

Nine studies reported across 15 publications were included involving 70824 pregnant women. The results showed that MFA levels were significantly higher in women who formally counted fetal movements than those who did not (standardized mean difference=0.72; 95% CI: 0.10–1.33, five studies, 1565 women). There were no differences between the groups in maternal anxiety or worry/concern outcomes. Attendance or admission rates for reduced fetal movements, or concern for fetal activity, did not differ between the groups (OR=1.36; 95% CI: 0.97–1.91, three studies, 1947 women). Compliance in completing fetal movement charts varied, ranging 45–90%, although definitions of compliance differed across studies, which may have affected rates.

CONCLUSIONS

This review has found that formal fetal movement counting in pregnancy has no detrimental effects on maternal psychological or emotional status and positively affects maternal–fetal attachment. Although current evidence does not support the use of formal fetal movement counting for improving perinatal outcomes, such as stillbirth and neonatal death, the results of this review are helpful for clinicians in discussing fetal movements in pregnancy and in discussing the optional methods available to women who may be advised to or choose to objectively assess fetal movements using a formal fetal movement counting method.

Assessing fetal movements in pregnancy: A qualitative evidence synthesis of women's views, perspectives and experiences

Background

Raising awareness of the importance of fetal movements (FMs) and advising women on the appropriate action to take if they experience reduced FMs, is important for minimising or avoiding adverse perinatal outcomes. To gain insight and understanding of women’s perspectives of assessing FMs in pregnancy, we conducted a qualitative evidence synthesis.

Methods

A qualitative evidence synthesis using thematic synthesis was conducted. Studies were eligible if they included pregnant women who were at least 20 weeks gestation and reported qualitative data from women on assessing FMs in pregnancy. MEDLINE, CINAHL, EMBASE, PsycINFO and Social Science Citation Index, from inception to July 2020, were searched. The methodological quality of included studies was assessed by at least two reviewers using an Evidence for Policy and Practice Information (EPPI)-Centre quality assessment tool. Data synthesis, using the Thomas and Harden framework, involved line by line coding of extracted data, establishing descriptive themes, and determining analytical themes. Confidence in the findings was assessed using GRADE CER-Qual.

Results

Nine studies, involving 2193 women, were included in the review. The methodological quality of the studies was overall generally high. The synthesis revealed three dominant themes, and seven sub-themes that reflected women’s perspectives of assessing FMs in pregnancy. These were; 1) How women engage with FMs, with subthemes of informal engagement, formal engagement, and strategies to stimulate FMs; 2) ‘ … like a feather inside my belly’ - articulating and describing FMs, with sub-themes of sensations associated with FMs and timing and frequency of FMs; and 3) FMs and help/health seeking, with sub-themes of information sources and interacting with healthcare professionals. Confidence in the findings was either high or moderate, although two findings were rated low confidence and one very low.

Conclusion

This qualitative evidence synthesis reveals that women informally engage with FMs during pregnancy. Women commonly adopt strategies to stimulate FMs when concerned. The use of the internet was a common source of obtaining information regarding FMs. Women require better support when contacting healthcare professionals about FMs. As only three of the nine included studies were exclusively qualitative in design, further qualitative studies exploring women’s perspective of assessing FMs in pregnancy are required.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03667-y.

Reduced Fetal Movements and Perinatal Mortality

Introduction:

Counting of fetal movement (FM) during pregnancy is believed to be a method by which a woman estimates the fetal well-being. In 2015, it was estimated that 2.6 million babies had died in utero. A percentage of 30-55% of women who experience an episode of reduced fetal movement (RFM) within a week may face stillbirth.

Aim:

The aim of this review was to assess the impact of reduced fetal movements and of educational interventions on maternal counting of fetal movements on perinatal mortality, perinatal outcome and mode of delivery.

Methods:

A search of electronic databases was conducted for detecting studies that examine the coincidence of reduced fetal movements (RFM) in combination with stillbirth and perinatal morbidity.

Results:

The findings of this review suggest that there is an association between the incidence of stillbirth and the experience of alterations in fetal movements’ quantity and quality in the preceding weeks. Interventions on fetal movement counting, concerning both the number and the density of fetal movements, may reduce the adverse perinatal outcomes to an extent, after informing and making aware of the pregnant women for their meaning.

Conclusion:

Maternity care professionals should: a) inform pregnant women about the importance of FM counting, b) encourage pregnant women to be familiarized on the recognition of theirs’ baby normal pattern of fetal movements and c) alarm women when this pattern changes. Care professionals should emphasize that counting of fetal movements is not related only to movements’ quantity (number) but also to movements’ quality (density).