PFM.71 Decreased fetal movements: risk of fetal growth restriction and stillbirth

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Abstract

Objective

We wanted to quantify the association between decreased fetal movements (DFM), fetal growth restriction (FGR) and stillbirth in a maternity population which routinely receives reminders throughout pregnancy about the significance of DFM.

Method

The database was collected between 2009 and 2012 from the national hand held maternity record, which contains auditable prompts for midwives to provide standard information along RCOG guidelines, including the need to present immediately with any change in perceived quality or frequency of fetal movements. FGR was defined as <10th customised birthweight centile. Multifetal pregnancies and congenital anomalies were excluded.

Results

Maternal presentation with one or more episodes of DFM was recorded in 23,621 of 108,102 pregnancies (21.9%). The FGR rate was 14.1% in pregnancies with DFM and 13.1% without (OR 1.09, CI 1.04–1.13). In stillbirths following DFM, the presentation with DFM was the first during the index pregnancy in 86%. The modal interval between presentation and delivery of a stillborn fetus was 2 days, with 56% occurring within 3 days or less. The stillbirth rate (/1000) was 4.1 overall, 9.4 in pregnancies with DFM, and 5.0 if stillbirths delivered within 3 days of DFM were excluded.

Conclusions

Pregnancies with DFM have only a slightly increased risk of FGR, which suggests this symptom is not a good screening method for abnormal fetal growth. In pregnancies ending in stillbirth, DFM appears to be a late manifestation, and its reported association with high stillbirth rates may in part be explained by in-utero deaths presenting with an absence of fetal movements.

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