Decrease In Fetal Movements Research Articles

Combined toxicity of polystyrene microplastics and sulfamethoxazole on zebrafish embryos.

Despite extensive investigation on the toxicity of microplastics (MPs), an emerging global concern, little is known about the combined toxicity of MPs and co-occurring pollutants in aquatic environments. In this study, the combined toxicity of polystyrene MPs and sulfamethoxazole (SMZ) antibiotics was explored in zebrafish embryos in terms of the developmental, physiological, and endocrine toxicities. Exposure to PS and SMZ induced mortality (rate: 25.0 ± 7.5%) and malformation (rate: 20~35%) at multiple regions and stages of zebrafish development. Physiological toxicity was also induced as shown by the significant decrease in fetal movement (by 31.1~37.0%) and swimming frequency (by 26.9~36.8%) and the increase in heartbeat rate (by 19.0~20.9%). Finally, PS and SMZ exposure also induced extensive endocrine toxicities in zebrafish as confirmed by increases in various biomarkers including vitellogenin, 17β-estradiol, testosterone, and triiodothyronine. The combination index showed that antagonistic effects were present between PS and SMZ toxicity, which slightly decreased their combined toxicity. This study aims to further understand the combined toxicity of MPs and co-occurring pollutants in aquatic environments.

THIS STUDY ASSESSES THE ROLE OF NST IN DETECTING FETAL COMPROMISE IN CASES OF REDUCED MATERNAL PERCEPTION OF FETAL MOVEMENT

Introduction:In modern era of medicine, antenatal fetal monitoring is an essential way that assess the fetal well being. Aims and objectives: This study was performed to test the association between non-stress test ( NST) results and fetal and perinatal outcomes in pregnant women with perceived decrease in fetal movements attending our hospital. To determine the role of Non stress test on fetal and prenatal outcome of pregnant women with perceived decrease in fetal movements attending labor room. Materials and methods: Study is carried out at 'Imambara District Hospital', at the Dept. Of obstetrics and gynaecology, Hooghly, WB. All the pregnant mother with decreased fetal movement perception in the 3rdtrimester, attending OBG (OPD) and ANC or getting admitted in Dept. OF OBSTETRICS AND GYNAECOLOGY, at IMAMBARADIST. HOSPITAL, Chinsurah, Hooghly, WB. 1st May 2018 – April 30, 2019. Conclusion: The antenatal surveillance of cases with reduced perception of fetal movement by mother with NST can effectively screen for identication of high risk foetuses and segregate the cases that are at risk for poor perinatal outcome.

Mindfetalness to increase women's awareness of fetal movements and pregnancy outcomes: a cluster-randomised controlled trial including 39865 women.

To examine whether a method for raising women's awareness of fetal movements, Mindfetalness, can affect pregnancy outcomes. Cluster-randomised controlled trial. Sixty-seven maternity clinics in Stockholm, Sweden. Women with singleton pregnancy with birth from 32weeks' gestation. Women registered at a clinic randomised to Mindfetalness were assigned to receive a leaflet about Mindfetalness (n=19639) in comparison with routine care (n=20226). Data were collected from a population-based register. Apgar score <7 at 5minutes after birth, visit to healthcare due to decrease in fetal movements. Other outcomes: Apgar score <4 at 5minutes after birth, small-for-gestational-age and mode of delivery. No difference (1.1 versus 1.1%, relative risk [RR] 1.0; 95% CI 0.8-1.2) was found between the Mindfetalness group and the Routine care group for a 5-minute Apgar score <7. Women in the Mindfetalness group contacted healthcare more often due to decreased fetal movements (6.6 versus 3.8%, RR 1.72; 95% CI 1.57-1.87). Mindfetalness was associated with a reduction of babies born small-for-gestational-age (RR 0.95, 95% CI 0.90-1.00), babies born after gestational week 41+6 (RR 0.91, 95% CI 0.83-0.98) and caesarean sections (19.0 versus 20.0%, RR 0.95; 95% CI 0.91-0.99). Mindfetalness did not reduce the number of babies born with an Apgar score <7. However, Mindfetalness was associated with the health benefits of decreased incidence of caesarean section and fewer children born small-for-gestational-age. Introducing Mindfetalness in maternity care decreased caesarean sections but had no effect on the occurrence of Apgar scores <7.

Perinatal features of Prader-Willi syndrome: a Chinese cohort of 134 patients

BackgroundPrader-Willi syndrome (PWS) is a rare and complex genetic disorder caused by lacking expression of imprinted genes on the paternally derived chromosome 15q11-q13 region. This study aimed to characterize the perinatal features of 134 Chinese individuals with PWS.MethodsThis study included the patients of a PWS registry in China. Anonymous data of 134 patients were abstracted. Perinatal and neonatal presentations were analyzed, and compared between the two PWS genetic subtypes. We also compared the perinatal features of PWS patients with the general population and other previous reported large cohorts from France, UK and USA.ResultsThis study included 134 patients with PWS (115 patients with 15q11-q13 deletion and 19 with maternal uniparental disomy). Higher mean maternal age was found in this cohort (30.5 vs. 26.7), particularly in the maternal uniparental disomy (UPD) group (36.0 vs. 26.7) comparing with the general population. 88.6% of mothers reported a decrease of fetal movements. 42.5 and 18.7% of mothers had polyhydramnios and oligohydramnios during pregnancy, respectively. 82.8% of the patients were born by caesarean section. 32.1% of neonates had birth asphyxia, 98.5% had hypotonia and 97.8% had weak cry or even no cry at neonatal period. Feeding difficulty existed in 99.3% of the infants, 94.8% of whom had failure to thrive. 69.4% of the infants ever used feeding tube during hospitalization, however, 97.8% of them discontinued tube feeding after discharge. Maternal age and pre-pregnancy weight were significantly higher in the UPD group (both P < 0.05).ConclusionsDifferential diagnosis of PWS should be highlighted if infants having following perinatal factors including polyhydramnios, decreased intrauterine fetal movements, caesarean section, low birth weight, feeding difficulty, hypotonia and failure to thrive. Higher maternal age may be a risk factor of PWS, especially for UPD. Further studies are needed for elucidating the mechanism of PWS.

Counting fetal movements of small-for-gestational infants using a fetal movement acceleration measurement recorder

Background: Our purpose was to clarify whether small-for-gestational (SGA) infants is associated with a decrease in fetal movements (FMs) even in the absence of hypoxia. We used a fetal movement acceleration measurement (FMAM) recorder, which enabled counting gross FMs for hours at a time.Methods: (1) Parameters of FMs for 13 women who delivered SGA infants were plotted over normal reference value curves made from 64 normal pregnant women in another study. (2) Linear regression analysis was conducted for the women with SGA infants and the normal pregnant women.Results: Thirty-eight data recordings were available in the SGA group. (1) For the ratio of movement positive 10-s epoch, 14 recordings (36.8%) were below 10% of the normal values. For an average number of movements, 13 (34.2%) were below 10%. Regarding average number, average duration, and longest duration of non-movement period, 12 (31.6%), 13 (34.2%), and 15 records (39.4%) were above 90% of the normal values, respectively. (2) SGA was a factor that decreased the positive epoch ratio and the average movements number, and increased the average number and duration, and the longest duration of non-movement period.Conclusions: SGA is associated with decreased movements even in the absence of hypoxia.

Legal Briefs: Head and Shoulder Trauma

A 4,580-g, 38 5/7 weeks’ gestation male infant was delivered by a 33-year-old gravida 5, para 1, aborta 1 woman whose pregnancy had been unremarkable. One month before delivery, the woman reported a decrease in fetal movement, but fetal activity resumed subsequently and the nonstress test result was normal. The pregnancy continued without problems. However, when labor began and the fetus did not descend, she received oxytocin to augment labor. Fetal tachycardia, decreased variability, and excessive uterine activity were noted. Also, inadequate rest time between contractions appeared as the second stage of labor was approaching. The plaintiff obstetrician pointed out that the fetus was being stressed since the peak of 1 contraction to the next peak should be at least 2 minutes, and the end of 1 contraction to the beginning of the next should be at least 1 minute. He also discussed that oxytocin should have been discontinued because of the lack of descent and the excessive uterine activity. The obstetrician retained by the defense said that technically tachysystole was not present and the tracing was category 2. He stated that the continuation of oxytocin was acceptable because the fetus was not descending adequately. The plaintiff obstetrician maintained that the tracings were concerning; the progression of labor was not appropriate; and it was clear, hours before delivery, that the pregnant woman could not safely deliver this fetus vaginally. Two and a half hours before delivery when the station was −1 and the cervix was fully effaced and dilated, the membranes were artificially ruptured. Thin, light brown, meconium-stained fluid was noted. The defense obstetrician said that the decreased fetal movement that had …

OP13.11: Placental mesenchymal dysplasia: four cases

We report prenatal diagnosis of four cases with placental mesenchymal dysplasia (PMD) and review of literature. Case 1: Primigravida of 15 weeks was referred for abnormal-appearing cystic placenta on ultrasound scanning, with hypoechoic areas. Normal fetal Doppler, and abnormal maternal Doppler. We diagnosed PMD and indicated treatment with heparin and aspirin. During third trimester intrauterine growth restriction (IUGR) was found. Caesarean section was performed at 38 w, new born was IUGR fetus. Placental pathology showed PMD. Case 2: Multiparous was sent because abnormal placental cyst. Normal fetal Doppler, abnormal maternal Doppler. PMD was diagnosed, heparin and aspirin were indicated. At 24 w, fetal mesenchymal tumours were found in liver, suprarenal and abdomen, showing an accelerated growth, with normal fetal Doppler. A decrease in fetal movements was objectified at 28 w. and finally at 29 w, fetal was death. Placental pathology showed PMD. Case 3: Primigravida of 21 w. referred with diagnosis of IUGR and partial mole. Fetus had absent diastolic flow in umbilical artery, abnormal maternal Doppler, normal ACM, multiple cystic images in placenta and HCG-B within normal values. With this findings, PMD was diagnosed. She started treatment with heparin and aspirin. At 34 w, pregnancy had to be finished due rupture of membranes, obtaining an IUGR fetus. Placental pathology showed PMD. Case 4: Patient of 23 weeks of pregnancy, obese, with normal fetus, placenta with multiple cystic images and abnormal maternal Doppler, aspirin was started. At 29 w. she presented headache, proteinuria, high blood pressure, and death. Placental pathology showed PMD. Conclusion: PMD is a rare placental disease. There are multiple theories, but the exact etiology of PMD is unclear. PMD is frequently misdiagnosis and have poor pregnancy outcome. Diagnosis should be considered with specific sonographic findings, including enlarged, cystic placenta with dilated chorionic vessels.

Acardiac Acephalus Twin Pregnancy with Poor Prenatal Outcomes: A Case Report

Introduction: Acardiac twin refers to a monochorionic pregnancy in which there is a twin with absent or nonfunctioning heart and a normal co-twin. This was a very rare disorder of monozygotic twin pregnancy. The aim of this report was to introduce a case of acardiac acephalus twin pregnancy. Case Presentation: A 32- year- old woman (G3 P2 L2) referred to the hospital because of a decrease in fetal movement at 32 weeks of gestation. Ultrasonography showed a dead fetus. Her earlier sonography showed the possibility of acardiac twin pregnancy, but she did not have any appropriate or special prenatal care for this problem. After delivery, there was a normal dead fetus without any gross abnormality and another acardiac fetus. Conclusions: Early diagnosis of acardiac twin pregnancy and appropriate prenatal care are of prime importance for appropriate intervention and best fetal outcomes.

Rationale, study protocol and the cluster randomization process in a controlled trial including 40,000 women investigating the effects of mindfetalness

BackgroundShortening pre-hospital delay may decrease stillbirth rates and rates of babies born with a compromised health. Stillbirth may be preceded by a decrease in fetal movements. Mindfetalness has been developed as a response to the shortcomings of kick-counting for the monitoring of fetal movements by the pregnant woman. We do not know if practicing Mindfetalness may diminish pre-hospital delay. Nor do we know if practicing Mindfetalness may increase or decrease the percentage of women seeking health care for unfounded, from a medical perspective, worry for her fetus' well-being. MethodsThis article describes the rationale, study protocol and the randomization process for a planned study randomly allocating 40,000 pregnant women to receive, or not receive, proactive information about practicing Mindfetalness. The unit of randomization is 63 antenatal clinics in the Stockholm area. Midwives in the antenatal clinics randomized to Mindfetalness will verbally inform about practicing Mindfetalness, hand out brochures (printed in seven languages) and inform about a website giving information about Mindfetalness. Routine care will continue in the control clinics. All information for the analyses, including the main endpoint of an Apgar score below 7 (e.g., 0–6 with stillbirth giving a score of 0), measured five minutes after birth, will be retrieved from population-based registers. ResultsWe have randomized 33 antenatal clinics to Mindfetalness and 30 to routine care. In two clinics a pilot study has been performed. One of the clinics randomly allocated to inform about Mindfetalness will not do so (but will be included in the intention-to-treat analysis). In October 2016 we started to recruit women for the main study. ConclusionThe work up to now follows the outlined time schedule. We expect to present the first results concerning the effects of Mindfetalness during 2018.

Temporal patterns in count-to-tenfetal movement charts and their associations with pregnancy characteristics: a prospective cohort study

BackgroundFetal movement counting has long been suggested as a screening tool to identify impaired placental function. However, quantitative limits for decreased fetal movement perform poorly for screening purposes, indicating the need for methodological refinement. We aimed to identify the main individual temporal patterns in fetal movement counting charts, and explore their associations with pregnancy characteristics.MethodsIn a population-based prospective cohort in Norway, 2009–2011, women with singleton pregnancies counted fetal movements daily from pregnancy week 24 until delivery using a modified "count-to-ten” procedure. To account for intra-woman correlation of observations, we used functional data analysis and corresponding functional principal component analysis to identify the main individual temporal patterns in fetal movement count data. The temporal patterns are described by continuous functional principal component (FPC) curves, with an individual score on each FPC for each woman. These scores were later used as outcome variables in multivariable linear regression analyses, with pregnancy characteristics as explanatory variables.ResultsFetal movement charts from 1086 pregnancies were included. Three FPC curves explained almost 99% of the variation in the temporal data, with the first FPC, representing the individual overall counting time, accounting for 91% alone. There were several statistically significant associations between the FPCs and various pregnancy characteristics. However, the effects were small and of limited clinical value.ConclusionsThis statistical approach for analyzing fetal movement counting data successfully captured clinically meaningful individual temporal patterns and how these patterns vary between women. Maternal body mass index, gestational age and placental site explained little of the variation in the temporal fetal movement counting patterns. Thus, a perceived decrease in fetal movement should not be attributed to a woman’s basic pregnancy characteristics, but assessed as a potential marker of risk.

Umbilical cord accidents

Umbilical cord accidents

Women's premonitions prior to the death of their baby in utero and how they deal with the feeling that their baby may be unwell

To identify whether mothers of stillborn babies had had a premonition that their unborn child might not be well and how they dealt with that premonition. Design. A mixed method approach. One thousand and thirty-four women answered a web questionnaire. Six hundred and fourteen women fulfilled the inclusion criteria of having a stillbirth after the 22nd gestational week and answered questions about premonition. Qualitative content analysis was used for the open questions and descriptive statistics for questions with fixed alternatives. The premonition of an unwell unborn baby. In all, 392 of 614 (64%) of the women had had a premonition that their unborn baby might be unwell; 274 of 614 (70%) contacted their clinic and were invited to come in for a check-up, but by then it was too late because the baby was already dead. A further 88 of 614 (22%) decided to wait until their next routine check-up, believing that the symptoms were part of the normal cycle of pregnancy, and that the fetus would move less towards the end of pregnancy. Thirty women (8%) contacted their clinic, but were told that everything appeared normal without an examination of the baby. Women need to know that a decrease in fetal movements is an important indicator of their unborn baby's health. Healthcare professionals should not delay an examination if a mother-to-be is worried about her unborn baby's wellbeing.

Pregnancy outcome following induction of labor with intravaginal misoprostol for decreased fetal movements at term

Objective. To determine the outcome of labor induction with intravaginal misoprostol among women with perception of persistent decrease in fetal movements at term.Method. The study group comprising 107 women who had induction of labor at term for primary complaint of decreased fetal movements (DFM) were compared with equal number of women who had induction for prolong pregnancy in a university teaching hospital.Results. Caesarean section rate (39.3% vs. 22.4%, P < 0.001) and birthweight less than 2500 g (11.2% vs. 2.8%, P = 0.02) were significantly higher in the DFM group with the leading indication for caesarean delivery being nonreassuring fetal heart rate. Also, the incidence of 5-min Apgar score <7 were significantly lower among women in the DFM group. However, there was no difference in neonatal unit admission. There was no case of early neonatal death in both groups of women.Conclusion. Intravaginal misoprostol for labor induction is a safe delivery option for women with perception of DFM with reassuring nonstress test. Since all cases with persistent decrease in fetal movements had reassuring nonstress test, the reduction in fetal movements was most likely due to altered perception.

A Case of Massive Meconium Peritonitis In Utero Successfully Managed by Planned Cardiopulmonary Resuscitation of the Newborn

We report a case of emergent massive meconium peritonitis due to intrauterine volvulus without malrotation. Fetal ascites was detected on a regular ultrasonographic examination, and fetal distress was found on cardiotocographic monitoring. The mother had noticed a slight decrease in fetal movements over the preceding 24 hours. Prenatal magnetic resonance imaging allowed us to distinguish the meconium from fetal peritoneal fluid and to evaluate the degree of compression of the fetal thoracic cavity. The infant was delivered by emergency cesarean section and demonstrated tense abdominal ascites with edema at birth. She required cardiopulmonary resuscitation and immediate paracentesis.

Fetal movements in the third trimester – Important information about wellbeing of the fetus

It can be quite natural for pregnant women to believe that a decrease in the frequency of fetal movements at the end of pregnancy is normal if they have been so informed. There is also probably scope for interpretation concerning what is to be regarded as a decrease in the number of movements. Non-evidence-based information that a decrease in fetal movements is normal during the third trimester poses a threat to the unborn baby’s life. If the mother does not react to a decrease in frequency and if she waits too long before contacting healthcare professionals, the window of opportunity to save the baby’s life may be closed.

The Fetal Cleft Palate: V. Elucidation of the Mechanism of Palatal Clefting in the Congenital Caprine Model

Failure of palatal shelf fusion at the precise gestational time point when shelf elevation and migration normally occur results in clefting. The present study defined the mechanism of clefting in the congenital caprine model by evaluating the temporal sequence of palatal shelf fusion. Six Spanish-type goats pregnant with twins were gavaged for 10 days (gestational days 32 to 41) with anabasine. Goats were examined with ultrasound throughout this period to assess fetal movement and evaluated histologically. Twelve untreated, unclefted fetuses served as controls. After anabasine induction, real-time ultrasound confirmed a dramatic decrease in fetal movement. Hyperflexion of the neck occurred throughout the experimental period compared with control fetuses, in which spontaneous neck movements occurred. Histologic evaluation of the induced fetuses demonstrated the tongue wedged between the palatal shelves throughout the period of fusion. The shelves remained vertically oriented without elevation, ultimately resulting in clefting. The unclefted, control group demonstrated progressive elevation and migration of the palatal shelves between gestational days 38 and 40, with contact and fusion of the medial edge epithelia in the midline. Palatal clefting in the congenital caprine model occurred concomitant with reduced fetal movement. Resultant neck hyperflexion causes the tongue to obstruct medial migration of the palatal shelves and fusion, whereas the shelves themselves are either directly prevented from elevation secondary to anabasine impairment or indirectly secondary to the obstructing tongue. Although the molecular mechanism for the teratogenic effects of anabasine remains elusive, the authors have demonstrated an association between reduced fetal movement and palatal clefting in their congenital caprine model.

A Case of Spinal Cord Injury That Occurred In Utero

Spinal cord injury is a rare occurrence that is often difficult to diagnose. This report describes a 2-year-old male with cervicothoracic spinal cord injury. The injury is thought to have occurred in the fetal period because the patient's thorax was markedly hypoplastic at birth and his mother had noticed a decrease in fetal movements for several weeks before the birth. The deep tendon reflex of the upper and lower extremities was absent at birth, as observed in other cases of spinal cord injury. It was noteworthy that deep tendon reflex of the upper and lower extremities remained decreased at 2 years of age despite the injury being located at C(7)-T(1). Based on this case, we propose that spinal cord injuries occurring in utero display different reflex responses from those occurring at birth.

What Syndrome Is This?

Pediatric DermatologyVolume 22, Issue 4 p. 366-368 What Syndrome Is This? Susan B. Mallory M.D., Susan B. Mallory M.D. Department of Dermatology, Farwaniya Hospital, KuwaitSearch for more papers by this authorBernice R. Krafchik M.B., Ch.B., F.R.C.P.C., Bernice R. Krafchik M.B., Ch.B., F.R.C.P.C. Department of Dermatology, Farwaniya Hospital, KuwaitSearch for more papers by this authorNawaf Al-Mutairi M.D., F.R.C.P., Corresponding Author Nawaf Al-Mutairi M.D., F.R.C.P. Department of Dermatology, Farwaniya Hospital, KuwaitAddress correspondence to Nawaf Al-Mutairi, M.D., F.R.C.P., P.O. Box: 280, Farwaniya, State of Kuwait, or e-mail: nalmut@usa.net.Search for more papers by this authorOsama Nour-Eldin M.D., Osama Nour-Eldin M.D. Department of Dermatology, Farwaniya Hospital, KuwaitSearch for more papers by this authorArun Joshi M.D., Arun Joshi M.D. Department of Dermatology, Farwaniya Hospital, KuwaitSearch for more papers by this authorAyman H. Hassanain M.D., Ayman H. Hassanain M.D. Department of Dermatology, Farwaniya Hospital, KuwaitSearch for more papers by this author Susan B. Mallory M.D., Susan B. Mallory M.D. Department of Dermatology, Farwaniya Hospital, KuwaitSearch for more papers by this authorBernice R. Krafchik M.B., Ch.B., F.R.C.P.C., Bernice R. Krafchik M.B., Ch.B., F.R.C.P.C. Department of Dermatology, Farwaniya Hospital, KuwaitSearch for more papers by this authorNawaf Al-Mutairi M.D., F.R.C.P., Corresponding Author Nawaf Al-Mutairi M.D., F.R.C.P. Department of Dermatology, Farwaniya Hospital, KuwaitAddress correspondence to Nawaf Al-Mutairi, M.D., F.R.C.P., P.O. Box: 280, Farwaniya, State of Kuwait, or e-mail: nalmut@usa.net.Search for more papers by this authorOsama Nour-Eldin M.D., Osama Nour-Eldin M.D. Department of Dermatology, Farwaniya Hospital, KuwaitSearch for more papers by this authorArun Joshi M.D., Arun Joshi M.D. Department of Dermatology, Farwaniya Hospital, KuwaitSearch for more papers by this authorAyman H. Hassanain M.D., Ayman H. Hassanain M.D. Department of Dermatology, Farwaniya Hospital, KuwaitSearch for more papers by this author First published: 21 July 2005 https://doi.org/10.1111/j.1525-1470.2005.22419.xCitations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume22, Issue4July 2005Pages 366-368 RelatedInformation

Macrotransfusion fœto-maternelle spontanée révélée par une diminution de la perception des mouvements actifs fœtaux

Massive fetomaternal hemorrhage is rare. Without risk factors, early diagnosis is difficult to establish. The clinical and paraclinical manifestations are not specific and depend on fetal compensatory reactions; the Kleihauer test will confirm the diagnosis. Two cases of massive fetomaternal hemorrhage preceded by decreased fetal movements are presented here. An emergency delivery by cesarean section saved one child. Despite a favorable clinical and laboratory evaluation, one fetal death could not be avoided. Early diagnosis and specialised management are essential to improve prognosis. These observations indicate that it is mandatory to carry out a Kleihauer test whenever a decrease of fetal movements is observed.

The use of Doppler in fetal monitoring

Mothers must be made aware of the importance of recognising any decrease in fetal movements and of notifying immediately their appropriate carers. Failure to do so featured significantly in a report on the incidence of stillbirths in the UK (CESDI, 1997). Electronic fetal heart monitoring provides accurate information of fetal wellbeing during antepartum and parturition but machines are confined to hospital premises and their use during delivery limits the mother's choice of birthing position. The rise in the use of Doppler devices has enabled midwives to monitor fetal heart rates in a mother's own home and even during a waterbirth delivery. Many mothers experience anxiety during the time in between obstetric examinations, especially following a previous problematic pregnancy. Low-cost Dopplers are available for purchase or hire by a mother for home use to reduce such worry.