PP23 Perinatal outcomes of reduced fetal movements: a prospective cohort study

Abstract

Background Reduced Fetal Movement (RFM) is a subjective decrease in the maternal perception of fetal activity in utero. It has been associated with adverse outcomes such as stillbirth and poor neonatal outcome. Our aims were: To assess the sociodemographic and obstetric characteristics of women presenting with RFM. To compare pregnancy outcomes of those presenting with RFM with a control group. Methods We conducted a prospective cohort study of women presenting to the Emergency Department (ED) with RFM over 28 weeks gestation with a singleton pregnancy to a tertiary-level maternity tertiary-level Irish maternity hospital (8300 deliveries per year) between April 2013 and October 2013. Pregnancy outcomes were compared to a randomly-sampled control group delivering contemporaneously, without RFM. RFM cohort data was obtained through detailed chart review, with limited control cohort data extracted from delivery suite records. Univariate analysis was performed using t-tests and Pearson’s Chi-squared test. Results In total, 275 women presented with RFM, with 264 in the control group. Of those with RFM, mean gestation at presentation to the ED was 36 weeks (range 28–40+5 weeks). Cardiotocography was performed in 274 (97.8%) cases, 20 of whom were non-reassuring. 197 (69.8%) of women had an ultrasound examination to assess Amniotic Fluid Index, with 34 demonstrating abnormalities. Following assessment, 26.5% (n = 73) of women were admitted, with 79.4% (n = 58) of these delivered during admission. Of the total cohort, 15.2% (n = 42) were induced for RFM. Between groups, there were no differences in maternal age, birth weights, parity or gestation at delivery. There were 4 stillbirths in the RFM cohort, translating to a rate of 14.5 per 1000 (95% CI: 0.0–29.1). There were no stillbirths in the control group, with the institutional stillbirth rate of 2.6 per 1000. Women with RFM were more likely to be nulliparous (50.2% vs 37%; p = 0.002) and have had an induction of labour (42.4% vs 27.9%; p = 0.02). A higher rate of admission to the neonatal unit was observed compared to the control group (10.1% vs 7.2%), but this was not significant. Discussion This prospective study found higher rates of stillbirth, increased rates of operative delivery and increased incidence of induction of labour in those with RFM. RFM was also more likely to affect primiparous women. Clear guidance would ensure uniform assessment and management of those with RFM. Further research is needed in this area to improve perinatal outcomes, with focus on introducing interventions to decrease operative delivery rates, as well as perinatal mortality rates.