Objectives

1. Management pathway of pregnant women who perceived decreased fetal movement in low risk population. O. Olowu, Min Hui Wong, Q.S. Naquib, F.O Odejinmi, M. Gupta, B. Dalwatly Department of Obstetrics and Gynaecology, Whipps Cross University Hospital, London. UK OPTIONALLOGO HERE Barts Health NHS Trust Methods Results Objectives Conclusions • To evaluate the current investigations and our local guideline, in management of women with decreased fetal movements (DFM) in low risk population. • Background: • A perception of DFM was first recognised in 1973 as a non-specific early warning sign of fetal distress or suboptimal intrauterine conditions [1]. • However, The National Institute for Clinical Excellence (NICE) 2008 guidelines stated that formal fetal movement counting and ultrasonography should not form part of routine antenatal care in the UK [2]. • Various studies have reported associations between DFM and low birth weight [3-4], oligohydramnios, preterm birth [3,5], placental insufficiencies [4] , inductions of labour and emergency caesarean sections (ECS) and stillbirths [1, 6]. • Fetal growth restriction is a significant factor contributing to the increased risk in these pregnancies [4, 7, 8]. • Until recently there is no national guideline on the management of these women. • Outcome Measures: Fetal growth restriction, mode of delivery, birth weight, admission to neonatal intensive care unit and fetal demise. • This was a prospective study of 160 low risk pregnant women, above 28 weeks gestation, who presented to antenatal day assessment unit, with a history of DFM alone, between April 2010 to May 2011. • Pre-study management pathway includes; • Blood pressure check, urinalysis for protainuria • Cardiotocography (CTG) for all women • Ultrasonography (USS) was indicated if symphyseal fundal height is suggestive of small for gestational age or in recurrent presentation of DFM • UAD were performed if FGR or oligihydramnios • Induction of labour (IOL) are considered after 38 weeks if recurrent presentation. • Patient’s information was entered into the data base prospectively includes • Socio-demographic • Gestation age at first and if recurrent presentations • Identification of other risk factors. • CTG and USS findings • Other outcome measures as above. • Thirty eight percent (60) of women underwent ultrasonography for fetal biometry, amniotic fluid volume, fetal morphology plus or minus umbilical artery Doppler (UAD) assessment • Sixty two percent (100) had CTG alone • This study suggests that women, who presented with perception of decreased fetal movement, should be investigated according to local or national guidelines, to identify fetuses at risk of FGR or fetal demise. • These women had increased risks fetal demise, FGR and oligohydramnios as showed in the results • Management pathway has been developed following this study in our unit. • This study also shows that the usefulness of ultrasonography in providing information after abnormality was detected in women with DFM was 6.6%, which is consistent with the reported quoted figures in the literature, range between 4.4-12% • The use of Doppler ultrasound in low-risk pregnancies has no demonstrable benefit in reducing the risk of perinatal deaths, only 3% (5) of women in the study had abnormal Doppler • Recommendation • Ultrasonography is recommended as a preliminary assessment tool, if the mother is clinically small for gestational age, post date pregnancies, recurrent presentation of DFM or if the initial assessment is not reassuring. • These should include estimated fetal weight, amniotic fluid assessment and fetal morphology • Ultrasound detected abnormal fetal biometry, amniotic fluid volume, fetal morphology in 60 women. Table 1 • The UAD was performed in 16, out of 20 women with FGR or Oligohydramnios (80%). Table 2 • CTG tracing was suspicious necessitating IOL or emergency delivery in 5% (8). • Table 3 showed delivery outcomes • Fetal birth weight < 10 centile of ideal weight was13% (21) • Admission to NICU was 6% (10) • Two (1.2%) cases of still birth were diagnosed at 33-34 weeks during the study Table 1 Table 2 References • Sadovsky E, Yaffe H. Daily fetal movement recording and fetal prognosis. Obstet Gynecol 1973;41:845-50. • NICE, The National Institute for Clinical Excellence, Antenatal care, routine care for the healthy pregnant women guideline, March 2008. • Valentin L, Marsal K. Pregnancy outcome in women perceiving decreased fetal movement. Eur J Obstet Gynecol Reprod Biol 1987;24:23-32. • Whitty JE, Garfinkel DA, Divon MY. Maternal perception of decreased fetal movement as an indication for antepartum testing in a low-risk population. Am J Obstet Gynecol1991;165:1084-8. • Sherer DM, Spong CY, Minior VK, Salafia CM. Decreased amniotic fluid volume at < 32 weeks of gestation is associated with decreased fetal movements. Am J Perinatol 1996;13:479-82. • Tveit JV, Saastad E, Bordahl PE, Stray-Pedersen B, Frøen JF. The epidemiology of decreased fetal movements. In: Annual conference of the Norwegian Perinatal Society; 2006; Oslo, Norway; 2006. • Fischer S, Fullerton JT, Trezise L. Fetal movement and fetal outcome in a low-risk population. J Nurse Midwifery 1981;26:24-30. • Heazell AE, Sumathi GM, Bhatti NR. What investigation is appropriate following maternal perception of reduced fetal movements? J Obstet Gynaecol 2005;25:648-50. Table 3