Daily Fetal Movement Count Chart : Reducing Perinatal Mortality in Low Risk Pregnancy

The effect of formal fetal movement counting on maternal psychological outcomes: A systematic review and meta-analysis

INTRODUCTION

Formally counting fetal movements in pregnancy is one of the oldest methods to assess fetal well-being. Although not routinely recommended in contemporary maternity care, due to a lack of evidence of its effectiveness, formal fetal movement counting is still practiced in many birth settings. Requesting women to formally count their fetal movements in a structured, objective way that can potentially improve maternal subjective outcomes such as worry or concern. The aim of this study was to evaluate the effect of formal fetal movement counting versus no formal counting, on maternal worry, concern or anxiety, and maternal-fetal attachment (MFA). Secondary outcomes were compliance with the intervention (counting method) and hospital admission/attendance for fetal activity concerns.

METHODS

CINAHL, MEDLINE and EMBASE were searched systematically for eligible studies from inception dates to June 2020, supplemented by searches of trial databases, grey literature and the reference lists of included studies. Randomized controlled and quasi-randomized trials were included in the review.

RESULTS

Nine studies reported across 15 publications were included involving 70824 pregnant women. The results showed that MFA levels were significantly higher in women who formally counted fetal movements than those who did not (standardized mean difference=0.72; 95% CI: 0.10-1.33, five studies, 1565 women). There were no differences between the groups in maternal anxiety or worry/concern outcomes. Attendance or admission rates for reduced fetal movements, or concern for fetal activity, did not differ between the groups (OR=1.36; 95% CI: 0.97-1.91, three studies, 1947 women). Compliance in completing fetal movement charts varied, ranging 45-90%, although definitions of compliance differed across studies, which may have affected rates.

CONCLUSIONS

This review has found that formal fetal movement counting in pregnancy has no detrimental effects on maternal psychological or emotional status and positively affects maternal-fetal attachment. Although current evidence does not support the use of formal fetal movement counting for improving perinatal outcomes, such as stillbirth and neonatal death, the results of this review are helpful for clinicians in discussing fetal movements in pregnancy and in discussing the optional methods available to women who may be advised to or choose to objectively assess fetal movements using a formal fetal movement counting method.

Diagnostic value of non stress test in latent phase of labor and maternal and fetal outcomes

Purpose:

The Non stress test (NST) is one of the significant diagnostic fetal wellbeing tests. The purpose of this study is to assess diagnostic value of NST during latent phase of labor by considering maternal and neonatal outcomes.

Subjects:

This case control study was performed on 450 healthy pregnant women with gestational ages between 38-42 weeks in AL-Zahra teaching hospital in Tabriz, Iran. All participants underwent NST after being admitted to labor during their latent phase of delivery. Participants were divided into two groups including the study group which included 150 participants with non-reactive NST results whereas 300 subjects with reactive NST results assigned in the control group. Subjects in both groups were hospitalized for pregnancy termination because of the delivery time. In order to find out the importance of routine performance of NST during delivery, the relationship between NST results and maternal and fetal outcomes was evaluated. Several criteria including type of delivery, meconium defecation, descent arrest, bradycardia, Apgar score, and still birth were compared between two groups.

Results:

Findings of this study showed that descent arrest occurred in 2.7% of the subjects in the study group, whereas it occurred in 4.7% of the participants in the control group (p=0.44). Bradycardia found in 28% of the participants in study group and 3.3% of the control group (p<0.001). The low Apgar score was found in 2.7% of case group however; no the low Apgar score detected in the control group. Meconium defecation observed in 11.3% of the subjects in the study group and 9.7% of the participants in control group (p=0.62). The amount of stillbirth was 2.7% in the study group and no stillbirths were found in control group. There was a significant difference between the results of both groups in terms of bradycardia, low Apgar score and cesarean section.

Conclusion:

Results of this study revealed that participants in study group with nonreactive NST results had more fetal complications than those with reactive NST results. NST was found to be a valuable diagnostic test for diagnosis of fetal distress during delivery in the latent phase. These findings of this study suggest that NST should be performed routinely as a valuable diagnostic test during the latent phase of delivery.

Diagnostic value of fetal movement counting by mother and the optimal recording duration

INTRODUCTION

Fetal movement counting is a method used by mother to quantify her baby's movements. However, the optimal number of movements and the ideal duration of counting them have not been recognized. The aim of this study was to determine the diagnostic value of the two common fetal movements counting methods by mother including "ten fetal movements counting in two hours" and "three fetal movements counting in one hour" and to compare the required mean time for counting fetal movements in the two methods.

METHODS

300 subjects were selected by random sampling among clients with complains of decreased fetal movements referring to AL-Zahra teaching hospital in Tabriz, Iran. Full training about how to perform the two methods of fetal movements counting and how to record in related tables was instructed by researcher. Immediately after counting movements, biophysical profile test was performed.

RESULTS

Among 291 mothers in the two groups, 99.7% had active fetuses based on both methods of fetal movement counting. 96.9% of these active fetuses obtained score of 10 in biophysical profile. There was a statistically significant relation between the results of both two methods of fetal movement counting and the biophysical profile as the gold standard. Sensitivity, specificity, positive and negative predictive values of both methods were equally 100%, 96%, 10% and 100%, respectively.Mean time (SD) for ten movement counting was 22.1(4.6) and for three movementcounting was 8.0(2.8) minutes

CONCLUSION

The findings of this study showed that fetal movement counting test can be used as an initial screening method in predicting fetal health.