[Reduced fetal movements--clinical management, recommendations and information].
BACKGROUND
We reviewed the Norwegian guidelines and clinical routines in delivery units and investigated whether guidelines for management of reduced fetal movements and information given to pregnant women were based upon evidence-based knowledge.


METHODS
All Norwegian delivery units responded to a questionnaire about their management of pregnancies with reduced fetal movements. Literature for professionals and pregnant women was found in databases, books and journals.


RESULTS
Clinical management varied significantly. All delivery units used a non-stress test when available, but few included ultrasound and Doppler examinations routinely. Five of 55 units advised women that absence of fetal movements up to 24 hours may be normal. National guidelines and university curricula recommend that distinct reduction of fetal movements require investigation. Formal kick counting was regarded as either useful, recommended or to be dissuaded. Information for pregnant women emphasises the importance of vigilance towards fetal movements, but have contradictory limits for normal fetal movements.


CONCLUSIONS
We have documented significant variation in clinical routines, which do not correlate with information given to pregnant women, the literature, or guidelines. This can lead to uncertainty for both pregnant women and health care professionals and may put patient safety at risk. There is a need for evidence-based guidelines.
Saastad
Eli
E
Nasjonalt folkehelseinstitutt, Divisjon for epidemiologi, Postboks 4404 Nydalen, 0403 Oslo. eli.saastad@fhi.no
Frøen
J Frederik
JF
D015148:Cardiotocography; D019317:Evidence-Based Medicine; D005260:Female; D005323:Fetal Monitoring / Q000379:methods / Q000592:standards; D005324:Fetal Movement / Q000502:physiology; D006801:Humans; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011795:Surveys and Questionnaires; D016216:Ultrasonography, Prenatal