Recurrent episodes of reduced fetal movement and pregnancy risk

A study published in Acta Obstetricia et Gynecologica Scandinavica (Bhatia et al 2019) has added to our knowledge about the issue of reduced fetal movements during pregnancy. This has been a ‘hot topic’ in recent years, with increased intervention being offered in many areas to women who feel that their baby’s movements have decreased, especially if they have repeated experiences of this. However, there is concern that, in our rush to try to prevent stillbirth, we are over-responding and causing more harm than good as the result of over-intervention.

The results of research in this area have been varied, and responses to such research findings are often highly emotive. So any new evidence in this area is a welcome step in our understanding of the issues.

The authors of this study set out, “To examine the outcomes and interventions in pregnant women presenting with a perception of reduced fetal movements (RFM), and to determine if repeated episodes of RFM increase the risk of adverse outcomes.” (Bhatia et al 2019).

They carried out, “a retrospective cohort study conducted in six NHS hospitals within the Thames Valley network region, UK and one neighbouring hospital, an area with approximately 31,000 births annually. All women with a primary presentation of perceived RFM after 24 completed weeks of gestation during the month of October 2016 were included in the study.” (Bhatia et al 2019).

In this study, researchers looked at the women’s medical records to see what the outcome of their pregnancy was. Medical records are always a bit problematic when it comes to research, because things aren’t always recorded accurately. Having said that, they are a handy, inexpensive and easily accessible source of data and are often used to collect useful data about the outcomes of lots of people; I’m just pointing out that, as with any type of data, there are pros and cons.

During the month in which the research was undertaken, 591 women presented with reduced fetal movements. The researchers calculated from hospital birth numbers that this was 22.6% of all the women who could have experienced this. Almost half of those women (46.2%) experienced more than one episode of reduced fetal movements. Three of the women who experienced reduced fetal movements went on to lose their baby, which was 0.5% of the total women who experienced reduced movements. Importantly, though, the losses occurred at the first episode and were not associated with recurrent episodes of reduced fetal movement.

In the authors’ words:

“This study suggests that about a fifth of all pregnant women are presenting with RFM and that nearly half of these women present at least twice. More than half of the cases either had an induction of labour or a pre labour caesarean section. The vast majority of women in this cohort had healthy babies, but there were 3 deaths; all diagnosed at first presentation. Moreover, in a further 2 babies delivery was expedited after the finding of an abnormal CTG. We find no evidence to support the notion that women with repeated episodes are at increased risk of adverse outcomes.” (Bhatia et al 2019).

Birth professionals may also be interested in the following part of the author’s discussion:

“Perception of fetal movements is affected by multiple influences; equally, the perception of RFM is very common. These, together with the very modest risks of markers of placental dysfunction in women with repeated episodes, and the contradictory data on birthweight, suggest that recurrent RFM is likely to be a poor discriminator of pregnancy risk. This is pertinent when multiple established risks factors, such as poor obstetric history, hypertension, SGA, abnormal uterine artery Doppler or cerebroplacental ratio already exist.” (Bhatia et al 2019).

The authors’ conclusion to their study is simple and clear:

“Reduced fetal movements, and recurrent episodes, are common, and lead to considerable resource usage and obstetric intervention. We found no evidence to suggest that recurrent episodes increase pregnancy risk.” (Bhatia et al 2019)

The paper has been published online ahead of print and can be found here.

 

If you’re a midwife or birth worker and you’d like to learn more about how to analyse research, or if you just want to get up-to-date with the evidence, come and join Sara and colleagues from around the world in one of our online courses! You’ll feel refreshed and inspired!
Bhatia M, Mitsi V, Court l et al (2019). The outcomes of pregnancies with reduced fetal movements: A retrospective cohort study.https://doi.org/10.1111/aogs.13671
Photo by Jordan Bauer on Unsplash

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