Abstract
BackgroundMaternal perception of reduced fetal movement (RFM) is associated with increased risk of stillbirth and fetal growth restriction (FGR). RFM is thought to represent fetal compensation to conserve energy due to insufficient oxygen and nutrient transfer resulting from placental insufficiency.ObjectiveTo identify predictors of poor perinatal outcome after maternal perception of reduced fetal movements (RFM).DesignProspective cohort study.Methods305 women presenting with RFM after 28 weeks of gestation were recruited. Demographic factors and clinical history were recorded and ultrasound performed to assess fetal biometry, liquor volume and umbilical artery Doppler. A maternal serum sample was obtained for measurement of placentally-derived or modified proteins including: alpha fetoprotein (AFP), human chorionic gonadotrophin (hCG), human placental lactogen (hPL), ischaemia-modified albumin (IMA), pregnancy associated plasma protein A (PAPP-A) and progesterone. Factors related to poor perinatal outcome were determined by logistic regression.Results22.1% of pregnancies ended in a poor perinatal outcome after RFM. The most common complication was small-for-gestational age infants. Pregnancy outcome after maternal perception of RFM was related to amount of fetal activity while being monitored, abnormal fetal heart rate trace, diastolic blood pressure, estimated fetal weight, liquor volume, serum hCG and hPL. Following multiple logistic regression abnormal fetal heart rate trace (Odds ratio 7.08, 95% Confidence Interval 1.31–38.18), (OR) diastolic blood pressure (OR 1.04 (95% CI 1.01–1.09), estimated fetal weight centile (OR 0.95, 95% CI 0.94–0.97) and log maternal serum hPL (OR 0.13, 95% CI 0.02–0.99) were independently related to pregnancy outcome. hPL was related to placental mass.ConclusionPoor perinatal outcome after maternal perception of RFM is closely related to factors which are connected to placental dysfunction. Novel tests of placental function and associated fetal response may provide improved means to detect fetuses at greatest risk of poor perinatal outcome after RFM.
Highlights
Despite advances in obstetric care stillbirth remains a significant complication of pregnancy
A maternal serum sample was obtained for measurement of placentally-derived or modified proteins including: alpha fetoprotein (AFP), human chorionic gonadotrophin, human placental lactogen, ischaemia-modified albumin (IMA), pregnancy associated plasma protein A (PAPP-A) and progesterone
Poor perinatal outcome after maternal perception of reduced fetal movement (RFM) is closely related to factors which are connected to placental dysfunction
Summary
Despite advances in obstetric care stillbirth remains a significant complication of pregnancy. In high income countries the lack of reduction in stillbirths is in part related to the lack of sensitive and specific tests to accurately identify women at highest risk so that intervention may be appropriately directed [2]. One clinical sign intimately related to stillbirth is a reduction in maternally-perceived fetal movements [3]. In infants who are alive at presentation, RFM is associated with increased incidence of stillbirth, fetal growth restriction (FGR) and fetomaternal haemorrhage [6,7]. Tests currently used to assess fetal wellbeing in women with RFM have limited sensitivity to predict fetal compromise and FGR [12]. Maternal perception of reduced fetal movement (RFM) is associated with increased risk of stillbirth and fetal growth restriction (FGR). RFM is thought to represent fetal compensation to conserve energy due to insufficient oxygen and nutrient transfer resulting from placental insufficiency
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