Pregnancy outcomes in women presenting with single versus multiple episodes of reduced fetal movements: A prospective observational study

Fetal movement counting may assist clinicians to intervene at the right time and improve perinatal outcomes, but may sometimes cause unnecessary interventions. A recent Cochrane review in 2015 concludes that there is insufficient evidence to influence practice. This prospective observational study was conducted to evaluate pregnancy outcomes of 103 pregnant women presenting with primary complaints of reduced fetal movements to our Institute. All patients underwent ultrasonography (USG) and non-stress testing (NST) as preliminary investigations and were followed up till delivery. Labor outcomes like onset of labor, mode of delivery, neonatal outcomes like APGAR scores, admission to NICU for > 24 hours, birth weight, neonatal complications and maternal complications were noted. One hundred and three pregnant women presented with reduced fetal movements, of whom, 65% were term primigravida between the ages of 18-26 years. 47.5% belonged to the high risk pregnancy group. The rates of admission (62.1%), induction (77.7%) and cesarean section (43.7%) were high in this group. Pregnancy outcomes did not differ between single and multiple episodes of reduced fetal movements. Based on risk categorization we found that a single episode of reduced fetal movement was associated with approximately 70% good neonatal outcomes, whereas there was 50% risk of adverse neonatal outcomes with multiple episodes. Though this was clinically significant we could not establish statistical significance for this result. Reduced fetal movement can occur in both low and high risk pregnant population. Pregnancy outcomes between single and multiple episodes of RFM were not significantly different.

Stillbirths preceded by reduced fetal movements are more frequently associated with placental insufficiency: a retrospective cohort study

Objectives Maternal report of reduced fetal movements (RFM) is a means of identifying fetal compromise in pregnancy. In live births RFM is associated with altered placental structure and function. Here, we explored associations between RFM, pregnancy characteristics, and the presence of placental abnormalities and fetal growth restriction (FGR) in cases of stillbirth. Methods A retrospective cohort study was carried out in a single UK tertiary maternity unit. Cases were divided into three groups: 109 women reporting RFM, 33 women with absent fetal movements (AFM) and 159 who did not report RFM before the diagnosis of stillbirth. Univariate and multivariate logistic regression was used to determine associations between RFM/AFM, pregnancy characteristics, placental insufficiency and the classification of the stillbirth. Results AFM or RFM were reported prior to diagnosis of stillbirth in 142 (47.2%) of cases. Pregnancies with RFM prior to diagnosis of stillbirth were independently associated with placental insufficiency (Odds Ratio (OR) 2.79, 95% Confidence Interval (CI) 1.84, 5.04) and were less frequently associated with maternal proteinuria (OR 0.16, 95% CI 0.07, 0.62) and previous pregnancy loss <24 weeks (OR 0.20, 95% CI 0.07, 0.70). When combined, AFM and RFM were less frequently reported in twin pregnancies ending in stillbirth and in intrapartum stillbirths. Conclusions The association between RFM and placental insufficiency was confirmed in cases of stillbirth. This provides further evidence that RFM is a symptom of placental insufficiency. Therefore, investigation after RFM should aim to identify placental dysfunction.

Impact of Covid-19 on attendances for a 1st episode of reduced fetal movements: A retrospective observational study

Background Prior studies have demonstrated an increased stillbirth rate. It was suggested that the COVID-19 pandemic may have impacted on attendances for reduced fetal movements. Thus, we sought to ascertain the impact of the pandemic on attendances for reduced fetal movements (RFM) in our unit, ultrasound provision for reduced fetal movements, and the stillbirth rate. Methods This was a single site retrospective cohort study involving all women complaining of a 1st episode of reduced fetal movements between 01/03/2020-30/04/2020 (COVID) to 01/03/2019-30/04/2019 (Pre-COVID). Data were retrieved from computerised hospital records and statistical analyses were performed using GraphPad Prism and SPSS. Results 22% (179/810) of women presented with a 1st episode of reduced fetal movements Pre-COVID compared to 18% (145/803) during COVID (p = 0.047). Primiparous women were significantly over-represented in this population with a 1.4-fold increase in attendances during COVID (67% vs 48%, p = 0.0005). Neither the total stillbirth rate nor the stillbirth rate amongst women who presented with reduced fetal movements changed during COVID. Ultrasound provision was not impacted by COVID with 95% of the scans performed according to local guidelines, compared to Pre-COVID (74%, p = 0.0001). Conclusions There is a significant decrease in 1st attendances for reduced fetal movements during COVID-19 pandemic. Primiparous women were 1.4 times more likely to attend with RFM. Women should be reassured that COVID-19 has not resulted in a decreased provision of care for RFM, and has not impacted on the stillbirth rate.

Multiple thromboses in a late preterm infant present at birth

A late preterm infant was born to a diabetic mother on a background of reduced fetal movements and a poor CTG. It was noted immediately at birth that there was pathology in both upper limbs. Targeted investigation led to the diagnosis of bilateral upper limb arterial thromboses. Prompt assessment and multidisciplinary discussion led to an individualised management plan resulting in a positive outcome.