Elsevier

Seminars in Perinatology

Volume 32, Issue 4, August 2008, Pages 243-246
Seminars in Perinatology

Fetal Movement Assessment

https://doi.org/10.1053/j.semperi.2008.04.004Get rights and content

Maternal perception of fetal movements is the oldest and most commonly used method to assess fetal well-being. While almost all pregnant women adhere to it, organized screening by fetal movements has seen variable popularity among health professionals. Early results of screening were promising and fetal movement counting is the only antepartum testing method that has shown effect in reducing mortality in a randomized controlled trial comparing testing versus no testing. Although awareness of fetal movements is associated with improved perinatal outcomes, the quest to define a quantitative “alarm limit” to define decreased fetal movements has so far been unsuccessful, and the use of most such limits developed for fetal movement counting should be discouraged.

Section snippets

Fetal Movements as a Sign of Fetal Well-Being

Maternal perception of fetal movements (FM) is the oldest and most commonly used method to assess fetal well-being.1 In most communities today, it is performed as unstructured screening to which almost all pregnant women adhere. Among women who have delivered a live-born baby, more than 99% agreed with the statement that it was important to them to feel the baby move every day.2 When they screen themselves as “positive” for decreased fetal movements (DFM), most will present their concerns to

Studies of Stillbirth Prevention by Fetal Movement Counting

There have only been two studies in total populations (all pregnancies) and two studies in mixed low-risk and high-risk populations evaluating the effect of FMC for all versus no FMC. In the total population studies, both were conducted as prospective cohorts with a control period followed by an intervention period. In 1986, Westgate and Jamieson in New Zealand reported a relative risk of stillbirth of 0.76 (0.55-1.04), and 0.56 (0.35-0.90) for stillbirths perceived as avoidable.6 In 1989,

Methods and Alarm Limits for Maternal Fetal Movement Counting

The concept of maternal FMC in the third trimester is based on the presumption that maternal perception of FM accurately reflects fetal activity or at least gross fetal body or limb movements. A range of methodologies from piezo-electric crystals to ultrasound scanning have been used for objective measures of FM, but every method has its limitations and a “gold standard” is difficult to define. In comparison with the ultrasound, the mean proportion of FM perceived by the mother ranges from 37

Any Future for Formal Fetal Movement Counting?

While self-screened women who present with concerns for DFM do manage to identify a high-risk population, the ongoing fetal movement screening overall still achieves limited success. An important limitation to the efficacy of screening using FM may be substandard management of mother's concerns for DFM, as we discuss elsewhere in this issue of Seminars in Perinatology. Currently, far too many women do not seem to appreciate the importance of fetal activity, and stillbirths are often preceded by

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      Adequate perception of activity is an indicator of fetal wellbeing whereas abnormal degree of movement raises concern for fetal compromise [3]. Thus, while there is no consensus for the optimal definition of decreased fetal movements (DFM) [9], women are encouraged to report decrease of them [10,11]. Studies that have addressed the clinical significance of DFM have had inconsistent findings.

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    This work was supported in part by The Norwegian Research Council, The Norwegian Women's Public Health Association, The Norwegian Medical Association, and Unexpected Child Death Society of Norway.

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