Predictors of poor perinatal outcome following maternal perception of reduced fetal movements--a prospective cohort study.
BACKGROUND
Maternal perception of reduced fetal movement (RFM) is associated with increased risk of stillbirth and fetal growth restriction (FGR). RFM is thought to represent fetal compensation to conserve energy due to insufficient oxygen and nutrient transfer resulting from placental insufficiency.


OBJECTIVE
To identify predictors of poor perinatal outcome after maternal perception of reduced fetal movements (RFM).


METHODS
Prospective cohort study.


METHODS
305 women presenting with RFM after 28 weeks of gestation were recruited. Demographic factors and clinical history were recorded and ultrasound performed to assess fetal biometry, liquor volume and umbilical artery Doppler. A maternal serum sample was obtained for measurement of placentally-derived or modified proteins including: alpha fetoprotein (AFP), human chorionic gonadotrophin (hCG), human placental lactogen (hPL), ischaemia-modified albumin (IMA), pregnancy associated plasma protein A (PAPP-A) and progesterone. Factors related to poor perinatal outcome were determined by logistic regression.


RESULTS
22.1% of pregnancies ended in a poor perinatal outcome after RFM. The most common complication was small-for-gestational age infants. Pregnancy outcome after maternal perception of RFM was related to amount of fetal activity while being monitored, abnormal fetal heart rate trace, diastolic blood pressure, estimated fetal weight, liquor volume, serum hCG and hPL. Following multiple logistic regression abnormal fetal heart rate trace (Odds ratio 7.08, 95% Confidence Interval 1.31-38.18), (OR) diastolic blood pressure (OR 1.04 (95% CI 1.01-1.09), estimated fetal weight centile (OR 0.95, 95% CI 0.94-0.97) and log maternal serum hPL (OR 0.13, 95% CI 0.02-0.99) were independently related to pregnancy outcome. hPL was related to placental mass.


CONCLUSIONS
Poor perinatal outcome after maternal perception of RFM is closely related to factors which are connected to placental dysfunction. Novel tests of placental function and associated fetal response may provide improved means to detect fetuses at greatest risk of poor perinatal outcome after RFM.
Maternal and Fetal Health Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.
Philip J
PJ
Dutton
Lynne K
LK
Warrander
Stephen A
SA
Roberts
Giovanna
G
Bernatavicius
Louise M
LM
Byrd
David
D
Gaze
Josh
J
Kroll
Rebecca L
RL
Jones
Colin P
CP
Sibley
J Frederik
JF
Frøen
Alexander E P
AE
Heazell
D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D006063:Chorionic Gonadotropin / Q000097:blood; D005260:Female; D005317:Fetal Growth Retardation / Q000097:blood / Q000175:diagnosis*; D005324:Fetal Movement / Q000502:physiology*; D005333:Fetus; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D008875:Middle Aged; D010465:Perception / Q000502:physiology*; D010927:Placental Insufficiency / Q000097:blood / Q000175:diagnosis* / Q000523:psychology; D010928:Placental Lactogen / Q000097:blood; D011247:Pregnancy; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis; D011296:Prenatal Diagnosis; D011374:Progesterone / Q000097:blood; D011446:Prospective Studies; D050497:Stillbirth; D000509:alpha-Fetoproteins / Q000032:analysis
D015415:Biomarkers; D006063:Chorionic Gonadotropin; D000509:alpha-Fetoproteins; D011374:Progesterone; D010928:Placental Lactogen; D011266:Pregnancy-Associated Plasma Protein-A