Decreased Fetal Movements are an Important Red Flag in Second Half of Pregnancy: A Case Report of Baby Saved by Mother’s Attention to Fetal Movements

Etwell Mari

doi:10.18314/cogo.v1i1.862

Abstract

Stillbirth affects over 2,500 families in Australia, New Zealand and over 2.64 million families worldwide annually. Stillbirths are often preceded by maternal perception of decreased fetal movement (DFM). DFM is also strongly linked to adverse perinatal outcomes such as neurodevelopmental disability, infection, fetal to maternal haemorrhage (FMH), emergency delivery, umbilical cord complications, small for gestational age (SGA) and fetal growth restriction (FGR /IUGR). Decreased fetal movements for some women may be associated with placental dysfunction, which could lead to fetal growth restriction and/or stillbirth. While evidence is still emerging in this area, some studies indicate that a reduction in stillbirth rates may be achieved by increasing maternal, clinician and community awareness about the importance of DFM. Fetal movements are an important simple maker of fetal wellbeing, while reduced fetal movements can be the early symptom of fetal compromise and failure to respond by a mother or maternity provider might lead to intrauterine fetal death (IUFD). Fetal movement counting (Fetal Kicks monitoring) is very controversial, maternal anxiety has been highlighted as a big issue in those who follow fetal kick counting advice. The value of maternal fetal movements (FM) monitoring has been assessed in a number of studies of pregnant women. There are conflicting results with most showing no overall reduction in perinatal losses even when fetal movement monitoring has been recommended. Fetuses that are experiencing sub acute and slow progressing fetal compromise can be saved if mothers detect reduced fetal activity and present to their midwife or Obstetrician.

Highlights

Stillbirth affects over 2,500 families in Australia, New Zealand and over 2.64 million families worldwide annually
Studies conducted on the correlation between maternal perception of fetal movements and fetal movements seen on ultrasound scan demonstrated large variations, with correlation rates between maternal perception and actual fetal movement ranging from 16-90%
A case-control study from the UK reported that IUGR was present in 11% of women with decreased fetal movement (DFM) compared with 0% in the control group, suggesting that persistent DFM may alert clinicians to the presence of IUGR

Summary

Introduction

Stillbirth affects over 2,500 families in Australia, New Zealand and over 2.64 million families worldwide annually. Studies conducted on the correlation between maternal perception of fetal movements and fetal movements seen on ultrasound scan demonstrated large variations, with correlation rates between maternal perception and actual fetal movement ranging from 16-90% This variation may be related to a number of factors, including fetal size, specific movement patterns of the baby, gestational age, amniotic fluid volume, medications, fetal sleep state, anterior placentation, smoking and parity. Studies have reported associations between, DFM and low birth weight, oligohydramnios, preterm birth, threatened preterm labour, congenital malformations and chromosomal abnormalities, fetal to maternal haemorrhage, perinatal brain injuries and disturbed neurodevelopment, intrauterine infections, low Apgar scores and acidaemia, hypoglycaemia, umbilical cord complications and placental insufficiency, emergency delivery, induction of labour and Caesarean section, stillbirths and neonatal deaths

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Discussion

Conclusion