Outcome of Management of Pregnant Women with Decreased Fetal Movements in a Resource Constrained Setting in Southwest Nigeria
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Abstract
Aims: To evaluate pregnant women with decreased fetal movements (DFM) identifying the risk factors and perinatal outcomes of such pregnancies.
Study Design: A case-control study.
Place and Duration of Study: Department of Obstetrics and Gynecology, Ekiti State University Teaching Hospital, Ado-Ekiti, between April 1 2017 and March 31 2018.
Methodology: Women with singleton pregnancy presenting to the Department with complaint of DFM (cases) after 28 weeks of gestation were recruited and compared with women with no complaint of DFM that delivered in the facility during the study period. Sociodemographic data, obstetric characteristics. Antenatal risk factors, mode of delivery and perinatal outcomes were obtained using a semi-structured questionnaire. Data collected were analyzed with SPSS and variables were compared using student t test and chi square or Fisher exact test while p value was <0.05.
Results: Out of 1439 women in the third trimester during the study period, 117 women had complaint of DFM with a prevalence of 12.3%. There was no statistical difference in the socio-demographic characteristics between the two groups; P>0.05. The mean gestational age at presentation and delivery were significantly lower among women with DFM (31.95 ± 1.81 weeks versus 37.46 ± 2.98 weeks; P=0.001 and 35.05 ± 1.47 weeks versus 37.46 ± 2.98 weeks; P=0.001 respectively). More women with DFM significantly had preeclampsia and intrauterine growth restrictions (P=0.002), oligohydramnios (p=0.016), caesarean delivery (P=0.005) and SCBU admission (P=0.009). The mean birth weight and Apgar scores at 1 minute were significantly lower in women with DFM (2.64 ± 0.54 kg versus 3.25 ± 0.57 kg; P=0.001 and 7.13 ± 0.68 versus 7.42 ± 0.82; P=0.003 respectively).
Conclusion: This study showed that women with DFM are a higher risk of operative delivery and poor perinatal outcome such birth weight and Apgar score. Maternal perception of fetal movements should form part of risk assessment during routine visits.
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References
Hantoushzadeh S, Sheikh M, Shariat M, Farahani Z. Maternal perception of fetal movement type: The effect of gestational age and maternal factors. J Matern Fetal Neonatal Med. 2015;28(6):713-727. DOI: 10.3109/14767058.2014.929112
Koshida S, Ono T, Tsuji S, Murakami T, Arima H, Takahashi K. Excessively delayed maternal reaction after their perception of decreased fetal movements in stillbirths: Population-based study in Japan. Women Birth; 2017. DOI: 10.1016/j.wombi.2017.04.005
Radestad I. Fetal movements in the third trimester–Important information about wellbeing of the fetus. Sex Reprod Healthc. 2010;1(4):119-121. DOI: 10.1016/j.srhc.2010.06.006
Poojari VG, Kumar SS, Vasudeva A. Obstetric and neonatal outcome among women presenting with reduced fetal movements in third trimester. Int J Reprod Contracept Obstet Gynecol. 2018;7(1):88-93. DOI: 10.18203/2320-1770.ijrcog20175488
Winje BA, Saastad E, Gunnes N, Tveit JV, Stray-Pedersen B, Flenady V, et al. Analysis of ‘count-to-ten’ fetal movement charts: A prospective cohort study. BJOG 2011;118(10):1229-1238. DOI: 10.1111/j.1471-0528.2011.02993.x
Warrander LK, Batra G, Bernatavicius G, Greenwood SL, Dutton P, Jones RL, et al. Maternal perception of reduced fetal movements is associated with altered placental structure and function. PLoS ONE. 2012;7(4):e34851. DOI: 10.1371/journal.pone.0034851
Hijazi ZR, East CE. Factors affecting maternal perception of fetal movement. Obstet Gynaecol Surv 2009;64(7):489-497.
Holm Tveit JV, Saastad E, Stray-Pedersen B, Bordahl PE, Froen JF. Maternal characteristics and pregnancy outcomes in women presenting with decreased fetal movements in late pregnancy. Acta Obstet Gynecol Scand. 2009;88(12):1345-1351. DOI: 10.3109/00016340903348375
Kuwata T, Matsubara S, Ohkusa T, Ohkuchi A, Izumi A, Watanabe T, et al. Establishing a reference value for the frequency of fetal movements using modified ‘count to 10’ method. J Obstet Gynaecol Res. 2008;34(3):318-323. DOI: 10.1111/j.1447-0756.2008.00791.x
Gardener G, Daly L, Bowring V, Burton G, Chadha Y, Ellwood D, et al. Clinical practice guideline for the care of women with decreased fetal movements. Brisbane: Centre of Research Excellence in Stillbirth. 2017;1-33.
Saastad E, Vangen S, Froen JF. Suboptimal care in stillbirths- A retrospective audit study. Acta Obstet Gynecol Scand. 2007;86(4):444-450. DOI: 10.1080/00016340701207724
McCarthy CM, Meaney S, O’Donoghue K. Perinatal outcomes of reduced fetal movements: A cohort study. BMC Pregnancy and Childbirth. 2016;16:169. DOI: 10.1186/s12884-016-0964-2
Froen JF. A kick from within-fetal movement counting and the cancelled progress in antenatal care. J Perinat Med. 2004;32(1):13-24. DOI: https://doi.org/10.1515/JPM
Smyth RMD, Taylor W, Heazell AE, Furber C, Whitworth M, Lavender T. Women’s and clinicians perspectives of presentation with reduced fetal movements: A qualitative study. BMC Pregnancy and Childbirth. 2016;16:280. DOI: 10.1186/s12884-016-1074-x
Sergent F, Lefevre A, Verspyck E, Marpeau L. Decreased fetal movements in the third trimester: What to do? Gynecologie Obstetrique et Fertilite. 2005;33(11):861-869. DOI: 10.1016/jgyobfe.2005.07.041
O’Sullivan O, Stephen G, Martindale EA, Heazell AE. Predicting poor perinatal outcome in women who present with decreased fetal movements- A preliminary study. J Obstet Gynecol. 2009;29(8):705-710. DOI: 10.3109/01443610903229598
Bradford B, Maude R. Maternal perception of fetal movements in the third trimester: A qualitative description. Women Birth; 2017. DOI: 10.1016/j.wombi.2017.12.007
Unterscheider J, Horgan R, O’Donoghue K, Greene R. Reduced fetal movements. Obstet Gynaecol. 2009;11(4):245-251. DOI: 101576/toag.11.4.2245.27527
Mangesi L, Hofmeyr GJ, Smith V, Smyth RM. Cochrane Collaboration. Fetal movement counting for assessment of fetal wellbeing. Cochrane Database Syst Rev. 2015;10:CD004909. DOI: 10.1002/14651858.CD004909.pub3
Tveit JV, Saastad E, Stray-Pedersen B, Bordahl PE, Flenady V, Fretts R, et al. Reduction of late stillbirth with the introduction of fetal movement information and guidelines - A clinical quality improvement. BMC Pregnancy Childbirth. 2009;9:32. DOI: 10.1186/1471-2393-9-32
Sheikh M, Hantoushzadeh S, Shariat M. Maternal perception of decreased fetal movements from maternal and fetal perspectives, a cohort study. BMC Pregnancy and Childbirth. 2014;14:286. DOI: 10.1186/1471-2393-14-286
Saastad E, Ahlborg T, Froen JF. Low maternal awareness of fetal movement is associated with small for gestational age infants. J Midwifery Womens Health. 2008;53(4):345-352. DOI: 10.1016/j.jmwh.2008.03.001
Olagbuji BN, Igbarumah S, Akintayo AA, Olofinbiyi BA, Aduloju PO, Alao OO. Maternal understanding of fetal movement in third trimester: A means for fetal monitoring and reducing stillbirth. Niger J Clin Pract. 2014;17(4):489-494. DOI: 10.4103/1119-3077.134049
Aduloju OP, Akintayo AA, Aduloju T, Akin-Akintayo OO. Birth preparedness and complication readiness among prenatal attendees in a teaching hospital in South West Nigeria. Int J Gynecol Obstet. 2017;139:202-210. DOI: 10.1002/ijgo.12271
Royal College of Obstetrics and Gynecology (RCOG) Reduced fetal movements. Green-top guideline No 57; 2011. (Accessed 25/09/2020) Available:https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg57/
Olesen AG, Svare JA. Decreased fetal movements: Background, assessment, and clinical management. Acta Obstet Gynecol Scand. 2004;83(9):818-826. DOI: 10.1111/j.0001-6349.2004.00603.x
Belay HG, Tamiru AT, Semahagn AM. Pregnancy outcomes of reduced fetal movement and its determinant factors: A case control study. Clinics Mother Child Health. 2020;17(4):354. DOI: 10.35248/2090-7214.20.17.354
O’ Neill E, Thorpe J. Antepartum evaluation of the fetus and fetal well being. Clin Obstet Gynecol. 2012;55(3):722-730. DOI: 10.1097/GRF.0b013e318253b318