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High intervention, low impact? A retrospective cohort study of management and outcomes of women presenting with decreased fetal movement

Year: 2025

Type: article

Abstract: PROBLEM: Women are encouraged to monitor fetal movements to reduce stillbirth, however the relationships between decreased fetal movements, birth interventions and perinatal outcomes are unclear. BACKGROUND: Decreased fetal movement is considered a risk factor for stillbirth, and clinical guidelines recommend assessment and management of affected women. AIM: To describe the characteristics, management and clinical outcomes of women presenting with decreased fetal movements at one Australian tertiary referral hospital. METHODS: Data on women reporting decreased fetal movements in the third trimester of pregnancy between 2019 and 2021 were extracted from the hospital database. Descriptive data are presented, and logistic regression was used to determine predictors of induction of labour, neonatal admission to SCU/NICU and Apgar score <7. FINDINGS: Among 193 women presenting for decreased fetal movement, clinical assessment and management varied. Induction of labour was common (45.6 %) and predicted by maternal diabetes (Adj OR 2.57 95 % CI 1.23-5.40), high BMI (Adj OR 2.56 95 % CI 1.18-5.58), primiparity (Adj OR 2.13 95 % CI 1.13-4.02), and multiple presentations (Adj OR 2.33 95 % CI 1.13-4.80). Of the babies, 37.8 % had morbidity, most frequently small for gestational age, intrauterine growth restriction and hypoglycaemia, and 14.5 % required specialist care. We did not identify any predictors of neonatal admission to SCU/NICU and Apgar score <7. There was one stillbirth and one perinatal death. DISCUSSION: A high proportion of women presenting with decreased fetal movements experienced intervention in labour and birth, without clear improvements to perinatal outcomes. CONCLUSION: Further research is needed to improve the balance between stillbirth prevention and unintended consequences of increased intervention, resulting from greater global attention to decreased fetal movement.

Source: Midwifery

DOI: 10.1016/j.midw.2025.104672

Authors: Victoria Chard, Nicola Irwin, Deborah Davis

Institutions: University of Canberra, Canberra Hospital, ACT Government

Language: English

Topic: Maternal and Perinatal Health Interventions

Subfield: Obstetrics and Gynecology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,630