title: Cardiotocography as a predictor of fetal outcome in women presenting with reduced fetal movement.
abstract: OBJECTIVE
  To examine the obstetric and perinatal outcomes of women presenting with reduced fetal movement (RFM) during the third trimester, specifically in relation to the diagnostic capacity of non-stress cardiotocography (CTG) used as the primary investigation in this clinical scenario.
  
  
  METHODS
  This was a retrospective population-based cohort study of pregnancy outcomes of all women ≥ 28 weeks' gestation with singleton pregnancies presenting during one calendar year with maternal perception of RFM, all of whom underwent CTG at presentation. Main outcome measures included: obstetric intervention (induction of labour, spontaneous vaginal delivery, operative vaginal delivery, emergency caesarean section), and perinatal outcome (subsequent perinatal death, low Apgar scores (<7(5)), neonatal resuscitation and NICU admission).
  
  
  RESULTS
  In all, 524 women presented with RFM and a live fetus, representing 7% of the antenatal obstetric population; 284 women (54%) were nulliparous. The reassuring CTG group comprised 482 (92%) women in whom initial CTG was reassuring and 15 (3%) where a repeat tracing within 1h was reassuring. The non-reassuring/abnormal CTG group (n=27, 5%) either underwent emergency delivery or comprehensive serial fetal assessment; this group had significantly higher rates of emergency caesarean delivery, neonatal resuscitation and NICU admission; the incidence of small-for-gestational-age infants did not differ significantly. No perinatal death occurred in either group following CTG.
  
  
  CONCLUSIONS
  Normal non-stress CTG is a reliable screening indicator of fetal wellbeing in women presenting with perception of RFM in the third trimester; abnormal pregnancy outcomes were more common when initial CTG was abnormal or persistently non-reassuring.
authors: National Maternity Hospital, Dublin, Ireland.
authors: Niamh
authors: N
authors: Daly
authors: Donal
authors: D
authors: Brennan
authors: Michael
authors: M
authors: Foley
authors: Colm
authors: C
authors: O'Herlihy
mesh_terms: D001034:Apgar Score; D015148:Cardiotocography; D002585:Cesarean Section; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005316:Fetal Distress / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D005324:Fetal Movement; D006340:Heart Rate, Fetal; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008499:Medical Records; D011247:Pregnancy; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third; D011296:Prenatal Diagnosis / Q000379:methods*; D012151:Resuscitation; D012189:Retrospective Studies