title: A prospective evaluation of fetal movement screening to reduce the incidence of antepartum fetal death.
abstract: Fetal death is a tragedy for mother, family, and obstetrician. Recent reviews of fetal death indicate that nearly half occur in pregnancies that are not candidates for traditional antepartum testing. We conducted a prospective evaluation of the effectiveness of a fetal movement screening program in reducing the fetal mortality rate. During a 7-month control period, 2519 deliveries occurred, no formal fetal movement assessment was done, and the fetal mortality rate was 8.7 per 1000 births. A pilot study was conducted to validate a protocol in which the patient was instructed to record the elapsed time required to appreciate 10 fetal movements. The mean time interval was 20.9 +/- 18.1 minutes (mean +/- SD). Patients in whom 2 hours elapsed without 10 fetal movements (mean +/- 5 SD) were to report to the delivery unit for further evaluation. During the study period, 1864 patients were delivered of infants and the fetal mortality rate was 2.1 per 1000 (chi 2 = 6.8, p less than 0.01). During the study period the number of antepartum tests performed increased by 13%. Interventions for fetal compromise prompted by inadequate fetal activity tripled in the study period, resulting in a drop in fetal mortality among patients with decreased movement from 44 to 10 per 1000. We conclude that the count-to-10 fetal movement screening program is simple and effective in reducing the fetal mortality rate.
authors.affiliation: Department of Obstetrics and Gynecology, U.S. Naval Hospital, San Diego, CA.
authors.forename: T R
authors.initials: TR
authors.lastname: Moore
authors.forename: K
authors.initials: K
authors.lastname: Piacquadio
mesh_terms: D002140:California; D002940:Circadian Rhythm; D005260:Female; D005313:Fetal Death / Q000453:epidemiology / Q000517:prevention & control*; D005323:Fetal Monitoring; D005324:Fetal Movement; D006801:Humans; D008889:Military Personnel; D010349:Patient Compliance; D010865:Pilot Projects; D011247:Pregnancy; D015397:Program Evaluation; D011446:Prospective Studies; D012307:Risk Factors