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Decreased fetal movements—the utility of ultrasound to identify infants at risk and prevent stillbirth is poor

Authors :
Jessica M, Turner
Rob, Cincotta
Jacqueline, Chua
Glenn, Gardener
Scott, Petersen
Joseph, Thomas
Alison, Lee-Tannock
Sailesh, Kumar
Source :
American Journal of Obstetrics & Gynecology MFM. 5:100782
Publication Year :
2023
Publisher :
Elsevier BV, 2023.

Abstract

Despite a paucity of evidence, it is widely accepted that a perceived reduction in fetal movements is associated with an increased risk of stillbirth and poor obstetrical outcome. Consequently, many international guidelines recommend urgent ultrasound assessment of fetal well-being in women presenting with decreased fetal movements.This study aimed to compare rates of abnormal ultrasound findings reflective of fetal compromise between women presenting with decreased fetal movements and gestation-matched controls in the third trimester.This was a retrospective cohort study performed at the Mater Mothers' Hospital in Brisbane between 2017 and 2020. We undertook propensity score matching analysis comparing abnormal ultrasound parameters in women with singleton, nonanomalous pregnancies presenting with decreased fetal movements after 28 weeks' gestation. The primary outcome was a composite of any abnormal scan parameter: umbilical artery pulsatility index95th centile, middle cerebral artery pulsatility index5th centile, cerebroplacental ratio10th centile, estimated fetal weight10th centile for gestation, middle cerebral artery peak systolic velocity1.5 multiples of the median, or deepest vertical pocket of amniotic fluid2 or8 cm.After propensity score matching, the study cohort comprised 1466 cases and 2207 controls. The rate of the primary composite outcome was not significantly different between the 2 cohorts (20.2% vs 21.3%; P=.42). There were 30 new cases of small-for-gestational-age detected in the decreased fetal movements cohort, giving a number needed to scan of 48 in the decreased fetal movements group to detect 1 case of small-for-gestational-age. However, the frequency of the composite outcome was higher (13.0% vs 5.4%) at the final scan before birth in women with multiple decreased fetal movement presentations. Despite this, there was no significant difference in clinical outcomes between the 2 cohorts.Ultrasound abnormalities are not increased in women with decreased fetal movements compared with controls.

Details

ISSN :
25899333
Volume :
5
Database :
OpenAIRE
Journal :
American Journal of Obstetrics & Gynecology MFM
Accession number :
edsair.doi.dedup.....f21a54485e1e32f3e8ed23a54ef6b4f4
Full Text :
https://doi.org/10.1016/j.ajogmf.2022.100782