title: Midwives' and obstetricians' knowledge and management of women presenting with decreased fetal movements.
abstract: BACKGROUND
  Maternal perception of decreased fetal movements (DFM) affects 5-15% of pregnancies. DFM is associated with intra-uterine fetal death (IUFD) and intra-uterine growth restriction (IUGR). It has been proposed that maternal perception of DFM may be used as a screening tool for IUFD or IUGR. However, this proposal is complicated by variations in definitions and management of DFM.
  
  
  OBJECTIVE
  We hypothesised that uncertainties in the definition and management of women presenting with DFM leads to variation in clinical practice.
  
  
  METHODS
  A postal questionnaire was sent to midwives and consultant obstetricians in the UK.
  
  
  RESULTS
  The majority of respondents enquired about the presence of fetal movements after 28 weeks gestation. There was little agreement on a definition of DFM, with a maternal perception of decreased movements for 24 h gaining the greatest acceptance. Few practitioners used formal fetal movement counting, with the majority of respondents stating they were ineffective in the prevention of IUGR or IUFD and led to increased intervention. There was large variation in the knowledge of associations with DFM and management of women presenting with DFM.
  
  
  CONCLUSIONS
  There were wide variations in the practice of obstetricians and midwives with regard to women presenting with DFM; many aspects of practice were not based on the available evidence. The variation in practice may result from a lack of robust evidence on which to base the provision of care. Further research is needed to provide and disseminate evidence to direct the management of women presenting with DFM.
authors.affiliation: Maternal and Fetal Health Research Group, University of Manchester, Manchester, UK. alex_heazell@talk21.com
authors.forename: Alexander E P
authors.initials: AE
authors.lastname: Heazell
authors.forename: Matthew
authors.initials: M
authors.lastname: Green
authors.forename: Caroline
authors.initials: C
authors.lastname: Wright
authors.forename: Vicki
authors.initials: V
authors.lastname: Flenady
authors.forename: J Frederik
authors.initials: JF
authors.lastname: Frøen
mesh_terms: D005260:Female; D005313:Fetal Death / Q000175:diagnosis; D005317:Fetal Growth Retardation / Q000175:diagnosis; D005323:Fetal Monitoring / Q000379:methods* / Q000592:standards; D005324:Fetal Movement / Q000502:physiology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008880:Midwifery; D010820:Physicians; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology*