THE OUTCOME FOR REDUCED FETAL MOVEMENTS IN SINGLETON PREGNANCIES AFTER 24 WEEKS

1. OPTIONALLOGO HERE THE OUTCOME FOR REDUCED FETAL MOVEMENTS IN SINGLETON PREGNANCIES AFTER 24 WEEKS Shaheeran Hayi, Dr. Jumeah Samsudin, Dr. Ng Poh Yin, Dato’ Dr. Ravindran J. Department of Obstetrics and Gynaecology, Kuala Lumpur Hospital, Jalan Pahang, 50586 Kuala Lumpur OPTIONALLOGO HERE Methods Results Objectives Conclusions To identify the maternal and fetal outcomes after reduced fetal movements in singleton pregnancies after 24 weeks of gestation. Retrospective data collection on all singleton pregnancies after 24weeks gestation who were admitted for reduced fetal movements in Kuala Lumpur Hospital between 1st January until 31st December 2010. Collectively there were a total of 303 patients who were seen in the Patient Assessment Center (PAC) for reduced fetal movements. Dates were verified by using their LMP (last menstrual period) or 1st trimester scan. All mothers were given the fetal kick chart for documentation and to attend hospital if they felt less than 10kicks in 12hours (between 9am to 9pm). The results were analyzed by statistical methods using EXCEL. Almost all mothers had normal CTG on admission. Only 3 mothers had suspicious CTG and underwent emergency caesarean section for that indication. 91% of mothers expressed increased anxiety about the presenting complaint, while some were unable to care for other children or were taken away from work due to the ward admission. Up to 90% of mothers were managed conservatively. This would constitute admission and observation of their fetal kicks throughout the next 24 hours. However almost one third of mothers required active intervention either by induction of labour or emergency caesarean section if they had either abnormal CTG or other risk factors for stillbirths. Only 4 mothers with reduced fetal movements actually had intrauterine death with subsequent macerated stillbirth, but no low apgar score, neonatal death or encephalopathy. Most had good fetal outcome. • Routine fetal kick chart is not recommended, in line with the Green Top Guideline on Reduced Fetal Movement no. 57(2011) and NICE guidelines on Antenatal Care CG 62 (2008). It has been shown to increase maternal anxiety and unnecessary intervention without improving the perinatal outcome. • Almost all reduced fetal movement had good fetal outcome and could have been managed as an outpatient with adequate counselling and reassurance to the mothers. • A change of practice in antenatal care in Malaysia is advocated with regards to reduced fetal movements in order to avoid unnecessary hospital admission, escalating cost of healthcare and maternal anxiety. References • Unterscheider J, Horgan R, O’Donoghue K, Greene R. Review Reduced Fetal Movements. The Obstetrician and Gynaecologist (TOG). Vol 11 , no.4 2009 • Green-Top Guidelines No. 57, Reduced Fetal Movements (Feb 2011). • NICE guidelines on Antenatal Care CG 62 (2008)