Antepartale Überwachung des fetalen Zustandes durch die mütterliche Aufzeichnung der Kindesbewegungen

Abstract

Perceived fetal activity is the oldest and least expensive technique for monitoring fetal well-being. The mother's awareness of a loss or a significant decrease in propulsive fetal activity has been traditionally regarded as a warning sign, especially when uteroplacental insufficiency is present. Many investigators have reported the value of daily fetal movement charting as a means for signalling fetal jeopardy and possible demise. Discerning between a physiological rest period and an abnormally low activity period is difficult but important. Several definitions of fetal inactivity according to maternal perception are described. The aim of our study was to detect abnormal fetal conditions by registering fetal body movements. For the evaluation we used the "Cardiff count to ten kick chart" developed by Pearson and Weaver. We evaluated 173 pregnant women after the 26th week of gestation in this way. Evidence for fetal inactivity are less than 10 movements/12 hours. 10% of the pregnancies showed fetal inactivity; half of them are expected to have an unfavourable outcome due to placental insufficiency and fetal distress during labour. Daily fetal movement charting is a simple and effective method for the detection of abnormal fetal conditions. It should be used in all high-risk pregnancies, especially in cases of incompatibility in the Rh-system, diabetes mellitus, and placental insufficiency. Our decision to intervene should not be based on fetal activity patterns alone, but the observation of fetal inactivity needs further investigation by ultrasonography (breathing activity, cardiac motion, lower limb and trunk motion, search for malformation, placental morphology and amniotic fluid volume) and cardiotocography.