High intervention, low impact? A retrospective cohort study of management and outcomes of women presenting with decreased fetal movement.

PROBLEM: Women are encouraged to monitor fetal movements to reduce stillbirth, however the relationships between decreased fetal movements, birth interventions and perinatal outcomes are unclear.

BACKGROUND

Decreased fetal movement is considered a risk factor for stillbirth, and clinical guidelines recommend assessment and management of affected women.

AIM: To describe the characteristics, management and clinical outcomes of women presenting with decreased fetal movements at one Australian tertiary referral hospital.

METHODS

Data on women reporting decreased fetal movements in the third trimester of pregnancy between 2019 and 2021 were extracted from the hospital database. Descriptive data are presented, and logistic regression was used to determine predictors of induction of labour, neonatal admission to SCU/NICU and Apgar score <7.

FINDINGS: Among 193 women presenting for decreased fetal movement, clinical assessment and management varied. Induction of labour was common (45.6 %) and predicted by maternal diabetes (Adj OR 2.57 95 % CI 1.23-5.40), high BMI (Adj OR 2.56 95 % CI 1.18-5.58), primiparity (Adj OR 2.13 95 % CI 1.13-4.02), and multiple presentations (Adj OR 2.33 95 % CI 1.13-4.80). Of the babies, 37.8 % had morbidity, most frequently small for gestational age, intrauterine growth restriction and hypoglycaemia, and 14.5 % required specialist care. We did not identify any predictors of neonatal admission to SCU/NICU and Apgar score <7. There was one stillbirth and one perinatal death.

DISCUSSION: A high proportion of women presenting with decreased fetal movements experienced intervention in labour and birth, without clear improvements to perinatal outcomes.

CONCLUSION

Further research is needed to improve the balance between stillbirth prevention and unintended consequences of increased intervention, resulting from greater global attention to decreased fetal movement.