Abstract
BackgroundFetal movement counting is a method used by the mother to quantify her baby's movements, and may prevent adverse pregnancy outcome by a timely evaluation of fetal health when the woman reports decreased fetal movements. We aimed to assess effects of fetal movement counting on identification of fetal pathology and pregnancy outcome.MethodologyIn a multicentre, randomized, controlled trial, 1076 pregnant women with singleton pregnancies from an unselected population were assigned to either perform fetal movement counting from gestational week 28, or to receive standard antenatal care not including fetal movement counting (controls). Women were recruited from nine Norwegian hospitals during September 2007 through November 2009. Main outcome was a compound measure of fetal pathology and adverse pregnancy outcomes. Analysis was performed by intention-to-treat.Principal FindingsThe frequency of the main outcome was equal in the groups; 63 of 433 (11.6%) in the intervention group, versus 53 of 532 (10.7%) in the control group [RR: 1.1 95% CI 0.7–1.5)]. The growth-restricted fetuses were more often identified prior to birth in the intervention group than in the control group; 20 of 23 fetuses (87.0%) versus 12 of 20 fetuses (60.0%), respectively, [RR: 1.5 (95% CI 1.0–2.1)]. In the intervention group two babies (0.4%) had Apgar scores <4 at 1 minute, versus 12 (2.3%) in the control group [RR: 0.2 (95% CI 0.04–0.7)]. The frequency of consultations for decreased fetal movement was 71 (13.1%) and 57 (10.7%) in the intervention and control groups, respectively [RR: 1.2 (95% CI 0.9–1.7)]. The frequency of interventions was similar in the groups.ConclusionsMaternal ability to detect clinically important changes in fetal activity seemed to be improved by fetal movement counting; there was an increased identification of fetal growth restriction and improved perinatal outcome, without inducing more consultations or obstetric interventions.Trial Registration ClinicalTrials.gov NCT00513942
Highlights
Maternal perception of a gradual diminishment of fetal activity is a significant marker of a vulnerable fetus and can indicate chronic fetal compromise [1,2,3,4,5], precede fetal growth restriction, stillbirth, preterm birth and emergency Caesarean section [6,7,8]
Maternal ability to detect clinically important changes in fetal activity seemed to be improved by fetal movement counting; there was an increased identification of fetal growth restriction and improved perinatal outcome, without inducing more consultations or obstetric interventions
The frequency of the primary outcome was equal between the groups; 63 of 433 (11.6%) in the intervention group, versus 53 of 532 (10.7%) in the control group [Relative Risk (RR): 1.1 95% confidence intervals (CI) 0.7–1.5) (p = 0.652)]
Summary
Maternal perception of a gradual diminishment of fetal activity is a significant marker of a vulnerable fetus and can indicate chronic fetal compromise [1,2,3,4,5], precede fetal growth restriction, stillbirth, preterm birth and emergency Caesarean section [6,7,8]. The fetal movement monitoring methods can be divided roughly into two understandings [15], formal fetal movement counting with specified limits for decreased fetal activity, as opposed to merely raising maternal awareness and vigilance to fetal activity and the significance of decreased fetal movement. The latter approach is consistent with national guidelines in the United Kingdom [16], the US [17] and Norway [18]. We aimed to assess effects of fetal movement counting on identification of fetal pathology and pregnancy outcome
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