title: Detection and management of decreased fetal movements in Australia and New Zealand: a survey of obstetric practice.
abstract: BACKGROUND
  Decreased fetal movement (DFM) is associated with increased risk of adverse pregnancy outcome. However, there is limited research to inform practice in the detection and management of DFM.
  
  
  OBJECTIVE
  To identify current practices and views of obstetricians in Australia and New Zealand regarding DFM.
  
  
  METHODS
  A postal survey of Fellows and Members, and obstetric trainees of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
  
  
  RESULTS
  Of the 1700 surveys distributed, 1066 (63%) were returned, of these, 805 (76% of responders) were currently practising and included in the analysis. The majority considered that asking women about fetal movement should be a part of routine care. Sixty per cent reported maternal perception of DFM for 12 h was sufficient evidence of DFM and 77% DFM for 24 h. KICK charts were used routinely by 39%, increasing to 66% following an episode of DFM. Alarm limits varied, the most commonly reported was < 10 movements in 12 h (74%). Only 6% agreed with the internationally recommended definition of < 10 movements in two hours. Interventions for DFM varied, while 81% would routinely undertake a cardiotocograph, 20% would routinely perform ultrasound and 20% more frequent antenatal visits.
  
  
  CONCLUSIONS
  While monitoring fetal movement is an important part of antenatal care in Australia and New Zealand, variation in obstetric practice for DFM is evident. Large-scale randomised controlled trials are required to identify optimal screening and management options. In the interim, high quality clinical practice guidelines using the best available advice are needed to enhance consistency in practice including advice provided to women.
authors.affiliation: Department of Obstetrics and Gynecology, University of Queensland, Brisbane, Queensland, Australia. vicki.flenady@mater.org.au
authors.forename: Vicki
authors.initials: V
authors.lastname: Flenady
authors.forename: Julie
authors.initials: J
authors.lastname: MacPhail
authors.forename: Glenn
authors.initials: G
authors.lastname: Gardener
authors.forename: Yogesh
authors.initials: Y
authors.lastname: Chadha
authors.forename: Kassam
authors.initials: K
authors.lastname: Mahomed
authors.forename: Alexander
authors.initials: A
authors.lastname: Heazell
authors.forename: Ruth
authors.initials: R
authors.lastname: Fretts
authors.forename: Frederik
authors.initials: F
authors.lastname: Frøen
mesh_terms: D001315:Australia; D002983:Clinical Competence; D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis; D005323:Fetal Monitoring / Q000379:methods* / Q000592:standards; D005324:Fetal Movement / Q000502:physiology*; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D009520:New Zealand; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011256:Pregnancy Outcome; D011795:Surveys and Questionnaires