Case–control study of factors associated with intrauterine deaths
To study the characteristics of pregnancies that resulted in stillbirth and to determine which may possibly predict intrauterine fetal death (IUFD).
A total of 161 singleton pregnancies resulting in stillbirth at Nottingham City Hospital from 1991 to 1997 were compared with 499 live births randomly selected from the same period of time. The variables studied were the following: customized birth weight for gestational age, fetal sex, histopathologic cause of IUFD, maternal age, ethnic group, parity, maternal body mass index (BMI), smoking habit, and maternal blood group.
In 54.7% of the cases of stillbirth at our institution women presented with reduction or absence of fetal movements before the diagnosis of IUFD. Almost half of the stillbirths (48.4%) were small for gestational age (< 10th percentile) on the basis of gestational age-specific weight. The difference in customized birth weight between stillbirths and live births was statistically significant (P <.0001). Increased maternal body mass index (BMI) was positively associated with stillbirth rate (P <.001), as was increased maternal age (P =.0012). Women with blood group O (P =.014) had an even higher stillbirth rate. There was no association between stillbirth rate and maternal ethnic group, maternal smoking, maternal Rhesus status, or fetal sex.
This study found that almost half of stillborn babies were small for gestational age. Reduced fetal activity should be investigated thoroughly, with formal measurement of fetal growth as part of this assessment. Maternal blood group and maternal age were found to be important factors in IUFD. Smoking was not confirmed in this study to be a significant factor.
Available from: Robyn M Maude
- "There has been very little improvement in stillbirth rates in high-income countries, in recent decades . In more than 50% of cases of stillbirth, the pregnant woman has identified decreased fetal activity prior to diagnosis of fetal death . An improved understanding of fetal behaviour in the context of adverse intra-uterine conditions is needed, so that new tools may be developed for identifying the fetus at risk . "
[Show abstract] [Hide abstract]
Maternal perception of decreased fetal movements is a specific indicator of fetal compromise, notably in the context of poor fetal growth. There is currently no agreed numerical definition of decreased fetal movements, with the subjective perception of a decrease on the part of the mother being the most significant definition clinically. Both qualitative and quantitative aspects of fetal activity may be important in identifying the compromised fetus. Yet, how pregnant women perceive and describe fetal activity is under-investigated by qualitative means. The aim of this study was to explore normal fetal activity, through first-hand descriptive accounts by pregnant women.
Using qualitative descriptive methodology, interviews were conducted with 19 low-risk women experiencing their first pregnancy, at two timepoints in their third trimester. Interview transcripts were later analysed using qualitative content analysis and patterns of fetal activity identified were then considered along-side the characteristics of the women and their birth outcomes.
This paper focuses on a novel finding; the description by pregnant women of fetal behaviour indicative of hunger and satiation. Full findings will be presented in later papers. Most participants (74% 14 of 19) indicated mealtimes were a time of increased fetal activity. Eight participants provided detailed descriptions of increased activity around meals, with seven (37% 7 of 19) of these specifying increased fetal activity prior to meals or in the context of their own hunger. These movements were interpreted as a fetal demand for food often prompting the mother to eat. Interestingly, the women who described increased fetal activity in the context of hunger subsequently gave birth to smaller infants (mean difference 364 gm) than those who did not describe a fetal response to hunger.
Food seeking behaviour may have a pre-birth origin. Maternal-fetal interaction around mealtimes could constitute an endocrine mediated communication, in the interests of maintaining optimal intrauterine conditions. Further research is warranted to explore this phenomenon and the potential influence of feeding on the temporal organisation of fetal activity in relation to growth.
Available from: Camille H Raynes-Greenow
- "Maternal perception of decreased fetal movement has been reported in 15% of pregnancies during the third trimester  and around 50% of women perceive a gradual reduction of fetal movement days before intrauterine death [6-8]. Thus early detection of reduced fetal movement has been considered as an opportunity for fetal health screening. "
[Show abstract] [Hide abstract]
Maternal perception of fetal movements has been used as a measure of fetal well-being. Yet a Cochrane review does not recommend formal fetal movement counting compared to discretional fetal movement counting. There is some evidence that suggests that the quality of fetal movements can precede quantitative changes however there has been almost no assessment of how women describe movements and whether these descriptions may be useful in a clinical setting. Therefore we aimed to examine maternal perception of fetal movements using a qualitative framework.
Using a cross-sectional design we identified women during routine antenatal care at a tertiary referral hospital, in Sydney, Australia. Eligible women were pregnant ≥ 28 weeks, carrying a single child, > 18 years old, and with sufficient English literacy to self-complete a questionnaire. Post-natally the medical records were reviewed and demographic, pregnancy and fetal outcome data were extracted. Text responses to questions regarding maternal descriptions of fetal movements throughout pregnancy, were analysed using thematic analysis in an explicit process.
156 women participated. There was a general pattern to fetal movement descriptions with increasing gestation, beginning with words such as “gentle”, to descriptions of “strong” and “limb” movements, and finally to “whole body” movements. Women perceived and described qualitative changes to fetal movements that changed throughout gestation. The majority (83%) reported that they were asked to assess fetal movements in an implicit qualitative method during their antenatal care. In contrast, only 16% regularly counted fetal movements and many described counting as confusing and reported that the advice they had received on counting differed.
This is the first study to use qualitative analysis to identify that pregnant women perceive fetal movements and can describe them in a relatively homogenous way throughout pregnancy that follow a general pattern of fetal growth and development. These findings suggest that women’s perception of fetal wellbeing based on their own assessment of fetal movement is used in an ad hoc method in antenatal care by clinicians.
Available from: Richard A Greene
- "It is recognised that an IUD is preceeded by cessation of FM for at least 24 hours (Sadovsky & Yaffe, 1973). Over 55% of women experiencing a stillbirth perceive a reduction in fetal movements prior to diagnosis (Efkarpidis et al., 2004). "
[Show abstract] [Hide abstract]
ABSTRACT: • Maternal perception of reduced fetal movements affects up to 15% of pregnancies.• Reduced fetal movements cause concern and anxiety and can be associated with poor pregnancy outcome.• Up to 29% of women complaining of diminished movements carry a small-for-gestational-age fetus.• Multiple pathologies contibute to reduce fetal movements but in many pregnancies a cause is not found.Learning objectives: • To establish what is meant by ‘reduced fetal movements’.• To understand the assessment tools for women presenting with reduced fetal movements.• To identify the fetus at risk of stillbirth and poor perinatal outcome.• To learn which investigations are useful and which are not, in order to apply appropriate assessment and management strategies.Ethical issues: • Lack of good data on the management of reduced fetal movements.• Failure to recognise pregnancy pathologies in women presenting with reduced fetal movements.• Variation in practice in addressing this condition, with the risk of adverse perinatal outcomes.• Risk of producing iatrogenic problems through over-investigation and unwarranted intervention in a healthy fetus.Please cite this article as: Unterscheider J, Horgan R, O'Donoghue K, Greene R. Reduced fetal movements. The Obstetrician & Gynaecologist 2009;11:245–251.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.