title: Predicting poor perinatal outcome in women who present with decreased fetal movements.
abstract: Maternal perception of decreased fetal movements (DFM) is associated with increased incidence of stillbirth and intrauterine growth restriction. We hypothesised that clinical assessment of women perceiving DFM may identify patients at highest risk of poor perinatal outcome. This was a retrospective study of 203 patients presenting to the obstetric triage service with DFM. Information on obstetric and past medical history, the current presentation with DFM and the outcome of pregnancy was collected. Using multivariate analysis, odds ratios (OR) and 95% confidence intervals (CI) were calculated for poor pregnancy outcome defined as stillbirth, small for gestational age or pre-term delivery. The rate of stillbirth was increased in women with DFM (OR 2.9). Some 26.6% of women perceiving DFM had a poor perinatal outcome. Women with relevant past obstetric history (OR 2.11), two or more presentations of DFM (OR 1.92), or who measured small-for-dates (OR 19.53) were at increased risk of poor pregnancy outcome. These preliminary data suggest that some features of clinical assessment can identify patients at increased risk of poor perinatal outcome after presentation with DFM. Such patients may be prioritised for detailed assessment of fetal growth and wellbeing.
authors.affiliation: Department of Obstetrics and Gynaecology, Royal Blackburn Hospital, Blackburn, UK.
authors.forename: O
authors.initials: O
authors.lastname: O'Sullivan
authors.forename: G
authors.initials: G
authors.lastname: Stephen
authors.forename: E
authors.initials: E
authors.lastname: Martindale
authors.forename: A E P
authors.initials: AE
authors.lastname: Heazell
mesh_terms: D000293:Adolescent; D000328:Adult; D016001:Confidence Intervals; D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis; D005323:Fetal Monitoring / Q000379:methods; D005324:Fetal Movement / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D050497:Stillbirth / Q000453:epidemiology*; D016216:Ultrasonography, Prenatal / Q000706:statistics & numerical data; D055815:Young Adult