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Background: Women experiencing decreased fetal movements (DFM) are at increased risk of adverse outcomes, including stillbirth. Fourteen delivery units in Norway registered all cases of DFM in a population-based quality assessment. We found that information to women and management of DFM varied significantly between hospitals. We intended to examine two cohorts of women with DFM before and during two consensus-based interventions aiming to improve care through: 1) written information to women about fetal activity and DFM, including an invitation to monitor fetal movements, 2) guidelines for management of DFM for health-care professionals.Methods: All singleton third trimester pregnancies presenting with a perception of DFM were registered, and outcomes collected independently at all 14 hospitals. The quality assessment period included April 2005 through October 2005, and the two interventions were implemented from November 2005 through March 2007. The baseline versus intervention cohorts included: 19,407 versus 46,143 births and 1215 versus 3038 women with DFM, respectively.Results: Reports of DFM did not increase during the intervention. The stillbirth rate among women with DFM fell during the intervention: 4.2% vs. 2.4%, (OR 0.51 95% CI 0.32-0.81), and 3.0/1000 versus 2.0/1000 in the overall study population (OR 0.67 95% CI 0.48-0.93). There was no increase in the rates of preterm births, fetal growth restriction, transfers to neonatal care or severe neonatal depression among women with DFM during the intervention. The use of ultrasound in management increased, while additional follow up visits and admissions for induction were reduced.Conclusion: Improved management of DFM and uniform information to women is associated with fewer stillbirths. [ABSTRACT FROM AUTHOR]

Objective: We aimed to describe patterns of maternally perceived fetal movement (FM) counts in normal third-trimester pregnancies and present associations between published limits of decreased fetal movement (DFM) and FM patterns in the total population., Design: Prospective cohort study., Setting: Norway, in 2005-2007 and 2007-2009., Population: The total population of women with singleton pregnancies., Methods: Using a 'count-to-ten' approach, women counted FMs daily from pregnancy week 28 until delivery. Data on maternal characteristics and birth outcomes were obtained from the Medical Birth Registry of Norway and hospital records. We measured the observed mean counting time and used chi-square and Mann-Whitney U-tests to examine differences between normal pregnancies and pregnancies with suboptimal outcomes., Main Outcome Measures: Fetal movements in normal pregnancies and in pregnancies ending in a small-for-gestational-age baby, preterm birth or non-elective caesarean section., Results: A total of 1786 women were included. The mean time to perceive ten movements was approximately 10 minutes in normal pregnancies, with a <2-minute increase in the mean towards term. Fixed limits for DFMs had low predictive values. Overall, the mean counting time in pregnancies with suboptimal outcomes did not differ markedly from normal pregnancies., Conclusions: This study does not support the notion that FM counts decrease at term in normal pregnancies. A standard approach to FM counting, applying the currently best-founded definition of DFM, was not useful as a screening tool for at-risk pregnancies in this population. Further research is needed to improve measurements of DFM., (© 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.)

Background: Delayed maternal reporting of decreased fetal movement (DFM) is associated with adverse pregnancy outcomes. Inconsistent information on fetal activity to women during the antenatal period may result in delayed reporting of DFM. We aimed to evaluate an intervention of implementation of uniform information on fetal activity to women during the antenatal period., Methods: In a prospective before-and-after study, singleton women presenting DFM in the third trimester across 14 hospitals in Norway were registered. Outcome measures were maternal behavior regarding reporting of DFM, concerns and stillbirth. In addition, cross-sectional studies of all women giving birth were undertaken to assess maternal concerns about fetal activity, and population-based data were obtained from the Medical Birth Registry Norway., Results: Pre- and post-intervention cohorts included 19 407 and 46 143 births with 1 215 and 3 038 women with DFM respectively. Among primiparous women with DFM, a reduction in delayed reporting of DFM (>/=48 hrs) OR 0.61 (95% CI 0.47-0.81) and stillbirths OR 0.36 (95% CI 0.19-0.69) was shown in the post-intervention period. No difference was shown in rates of consultations for DFM or maternal concerns. Stillbirth rates and maternal behavior among women who were of non-Western origin, smokers, overweight or >34 years old were unchanged., Conclusions: Uniform information on fetal activity provided to pregnant women was associated with a reduction in the number of primiparous women who delayed reporting of DFM and a reduction of the stillbirth rates for primiparous women reporting DFM. The information did not appear to increase maternal concerns or rate of consultation. Due to different imperfections in different clinical settings, further studies in other populations replicating these findings are required.

Objective: 'Normal' fetal activity is recognized as a sign of fetal well-being and concerns for decreased fetal movements is a frequent cause of non-scheduled antenatal visits. The aim of this study was to identify maternal characteristics in women presenting decreased fetal movements in a total population, to identify the risk of adverse outcomes and assess the management provided., Design: Prospective population-based cohort., Setting: Fourteen delivery units in Norway., Population: A total of 2,374 pregnancies presenting with a perception of decreased fetal movements and 614 control/referent cases., Methods: All singleton third trimester pregnancies presenting with a perception of decreased fetal movements were registered from June 2004 through October 2005. Pregnancies never examined for this condition were collected as a cross-sectional sample from the same population. Main outcome measures. Fetal growth restriction, preterm birth and stillbirth., Results: Mothers with decreased fetal movements were more often smokers, overweight and primiparous. Of the women, 32% presented with perceived absence of fetal movements, of whom 25% waited for more than 24 hours without any movements. Abnormal findings were identified in 16% of examinations. Decreased fetal movements were associated with adverse pregnancy outcome in 26%, including preterm birth and fetal growth restriction. An intervention or repeated consultations were performed in 41% of cases, including 14% admissions to maternity ward. None of the included hospitals had written guidelines for management., Conclusions: A perception of decreased fetal movements is significantly associated with adverse pregnancy outcome such as preterm birth, fetal growth restriction and stillbirth. Guidelines for management and information to pregnant women are needed.

Maternal perception of decreased fetal activity is a common complaint, and one of the most frequent causes of unplanned visits in pregnancy. No proposed definitions of decreased fetal movements have ever been proven to be superior to a subjective maternal perception in terms of identifying a population at risk. Women presenting with decreased fetal movements do have higher risk of stillbirth, fetal growth restriction, fetal distress, preterm birth, and other associated outcomes. Yet, little research has been conducted to identify optimal management, and no randomized controlled trials have been performed. The strong associations with adverse outcome suggest that adequate management should include the exclusion of both acute and chronic conditions associated with decreased fetal movements. We propose guidelines for management of decreased fetal movements that include both a nonstress test and an ultrasound scan and report findings in 3014 cases of decreased fetal movements.

Maternal perception of fetal movements is the oldest and most commonly used method to assess fetal well-being. While almost all pregnant women adhere to it, organized screening by fetal movements has seen variable popularity among health professionals. Early results of screening were promising and fetal movement counting is the only antepartum testing method that has shown effect in reducing mortality in a randomized controlled trial comparing testing versus no testing. Although awareness of fetal movements is associated with improved perinatal outcomes, the quest to define a quantitative "alarm limit" to define decreased fetal movements has so far been unsuccessful, and the use of most such limits developed for fetal movement counting should be discouraged.

Background: Reduced fetal movements imply a risk pregnancy. This condition is present in a significant proportion of pregnancies, but both the quality of information and that of clinical care is variable., Material and Methods: All delivery units in Eastern Norway and Bergen have registered all consultations for reduced fetal movements, as part of the international collaborative project "Fetal Movement Intervention Assessment" (Femina). Out of 23,933 deliveries, 1200 pregnancies were examined. In 1043 pregnancies the mother had spontaneously presented her concern over reduced fetal movements; these were included in analyses. Results are presented with a 95% confidence interval., Results: Asphyxia, death, growth restriction or preterm birth occurred in 19.6% (16.6-22.6%) of cases, ranging between units from 9.1% to 26.5%. Standard procedures varied extensively; ultrasonography was used in 39.0% to 98.6% and Doppler in 4.5% to 74.6% of cases. There was an association between outcomes and the procedures used. Women who waited 24 hours with reduced or absent movements before contacting healthcare had increased risk. Among those with absent movements, 47% (42-52%) had such risk behaviour., Interpretation: There is a need for quality improvements in the information to pregnant women as well as in the clinical management of affected pregnancies. This could have large health benefits. We propose new guidelines for information and management.