title: Number of episodes of reduced fetal movement at term: association with adverse perinatal outcome.
abstract: OBJECTIVE
  The aims of this study were evaluation of the association of reduced fetal movements (RFM) and small-for-gestational-age (SGA) birth at term and to explore if fetal and maternal outcomes are different with single vs repeated episodes of RFM and normal fetal assessment test results.
  
  
  METHODS
  This was a retrospective cohort study of all singleton pregnancies referred for RFMs at a tertiary fetal medicine unit from January 2008 through September 2014. Ultrasound and Doppler indices were obtained from a computerized ultrasound database and pregnancy outcome was collected from hospital records.
  
  
  RESULTS
  Of the 21,944 women with a singleton pregnancy booked for maternity care during the study period, 1234 women (5.62%) reported RFMs >36+0 weeks. Of these, 1029 women (83.4%) reported a single episode of RFM and 205 (16.6%) had ≥2 presentations for RFM. Women with repeated RFMs had a significantly higher mean uterine artery pulsatility index in the second trimester. The prevalence of SGA baby at birth in women presenting with a single episode as compared to repeated episodes of RFM was 9.8% and 44.2%, respectively (odds ratio, 7.3; 95% confidence interval, 5.1-10.4; P < .05).
  
  
  CONCLUSIONS
  Repeated episodes of RFMs at term are more likely to occur in women with high second-trimester uterine artery Doppler resistance indices and are strongly associated with the birth of SGA infants. Women presenting with repeated episodes of RFM should be treated as being at high risk of placental dysfunction irrespective of the results of prenatal ultrasound and Doppler assessment.
authors.affiliation: Fetal Medicine Unit, St George's Hospital, St George's University of London, London, United Kingdom. Electronic address: carolinascala@icloud.com.
authors.forename: Carolina
authors.initials: C
authors.lastname: Scala
authors.affiliation: Fetal Medicine Unit, St George's Hospital, St George's University of London, London, United Kingdom.
authors.forename: Amar
authors.initials: A
authors.lastname: Bhide
authors.affiliation: Fetal Medicine Unit, St George's Hospital, St George's University of London, London, United Kingdom.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Familiari
authors.affiliation: Fetal Medicine Unit, St George's Hospital, St George's University of London, London, United Kingdom.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Pagani
authors.affiliation: Fetal Medicine Unit, St George's Hospital, St George's University of London, London, United Kingdom.
authors.forename: Asma
authors.initials: A
authors.lastname: Khalil
authors.affiliation: Fetal Medicine Unit, St George's Hospital, St George's University of London, London, United Kingdom.
authors.forename: Aris
authors.initials: A
authors.lastname: Papageorghiou
authors.affiliation: Fetal Medicine Unit, St George's Hospital, St George's University of London, London, United Kingdom.
authors.forename: Basky
authors.initials: B
authors.lastname: Thilaganathan
mesh_terms: D000328:Adult; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging; D005324:Fetal Movement; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D016015:Logistic Models; D010927:Placental Insufficiency / Q000453:epidemiology; D011225:Pre-Eclampsia / Q000000981:diagnostic imaging; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018617:Ultrasonography, Doppler, Pulsed; D016216:Ultrasonography, Prenatal; D055988:Uterine Artery / Q000000981:diagnostic imaging
keywords: maternal outcomes; newborn outcomes; reduced fetal movements; small gestational age; uterine artery Doppler