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

  • Jessica M TURNER MRCOG
    Affiliations
    Mater Research Institute, University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland 4101, Australia

    Faculty of Medicine, University of Queensland, Whitty Building, Annerley Road, S. Brisbane, QLD 4101, Australia
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  • Rob CINCOTTA FRANZCOG
    Affiliations
    Mater Centre for Maternal & Fetal Medicine, Mater Mothers’ Hospital, Raymond Terrace, South Brisbane, Queensland 4101, Australia
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  • Jacqueline CHUA FRANZCOG
    Affiliations
    Mater Centre for Maternal & Fetal Medicine, Mater Mothers’ Hospital, Raymond Terrace, South Brisbane, Queensland 4101, Australia
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  • Glenn GARDENER FRANZCOG
    Affiliations
    Mater Centre for Maternal & Fetal Medicine, Mater Mothers’ Hospital, Raymond Terrace, South Brisbane, Queensland 4101, Australia
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  • Scott PETERSEN FRANZCOG
    Affiliations
    Mater Centre for Maternal & Fetal Medicine, Mater Mothers’ Hospital, Raymond Terrace, South Brisbane, Queensland 4101, Australia
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  • Joseph THOMAS FRANZCOG
    Affiliations
    Mater Centre for Maternal & Fetal Medicine, Mater Mothers’ Hospital, Raymond Terrace, South Brisbane, Queensland 4101, Australia
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  • Alison LEE-TANNOCK
    Affiliations
    Mater Centre for Maternal & Fetal Medicine, Mater Mothers’ Hospital, Raymond Terrace, South Brisbane, Queensland 4101, Australia
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  • Sailesh KUMAR FRCS FRCOG FRANZCOG
    Correspondence
    Corresponding author: Professor Sailesh Kumar, Mater Research Institute/University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, Australia
    Affiliations
    Mater Research Institute, University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland 4101, Australia

    Faculty of Medicine, University of Queensland, Whitty Building, Annerley Road, S. Brisbane, QLD 4101, Australia

    Mater Centre for Maternal & Fetal Medicine, Mater Mothers’ Hospital, Raymond Terrace, South Brisbane, Queensland 4101, Australia

    NHMRC Centre for Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland 4101, Australia
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Published:October 21, 2022DOI:https://doi.org/10.1016/j.ajogmf.2022.100782

      AJOG at a Glance

      • Why was this study conducted?
        A perceived reduction in fetal movements is believed to be associated with an increased risk of stillbirth and poor perintal outcome. As a consequence, many international guidelines recommend urgent ultrasound assessment of fetal wellbeing in women presenting with decreased fetal movements.
      • What are the key findings?
        There was no difference in rates of abnormal ultrasound findings between the decreased fetal movements group and controls. The number needed to scan to detect a new case of small for gestational age infant in the decreased fetal movements group was 48.
      • What does this study add to what is already known?
        The frequency of abnormal ultrasound findings are not increased in women with decreased fetal movements compared to controls. The value of an ultrasound scan to identify infants at risk of stillbirth or adverse neonatal outcomes in women reporting decreased fetal movements is questionable and clinicians should reappraise the utility of this investigation in this context.

      ABSTRACT

      Background

      : 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 obstetric outcome. As a consequence, many international guidelines recommend urgent ultrasound assessment of fetal wellbeing in women presenting with decreased fetal movements (DFM).

      Objective

      : To compare rates of abnormal ultrasound findings reflective of fetal compromise in women presenting with DFM and gestational matched controls in the third trimester.

      Study Design

      : A retrospective cohort study performed at the Mater Mother's Hospital in Brisbane between 2017-2020. We undertook propensity score matching (PSM) analysis comparing abnormal ultrasound parameters in women with singleton, non-anomalous pregnancies presenting with DFM after 28 weeks gestation. The primary outcome was a composite of any abnormal scan parameter: umbilical artery pulsatility index (PI) >95th centile or middle cerebral artery (MCA) PI <5th centile or cerebroplacental ratio (CPR) <10th centile or estimated fetal weight <10th centile for gestation or MCA peak systolic velocity >1.5 MoM, or deepest vertical pocket of amniotic fluid <2cm or >8cm.

      Results

      : After PSM, the study cohort comprised of 1,466 cases and 2,207 controls. The rate of the primary composite outcome was not significantly different between the two cohorts [20.2% vs 21.3%, p=0.42]. 30 new cases of SGA were detected in the DFM cohort, giving a number needed to scan of 48 in the DFM group to detect one case of SGA. The frequency of the composite outcome was however higher (13.0% vs 5.4%) at the final scan prior to birth in women with multiple DFM presentations. Despite this, there was no significant difference in clinical outcomes between the two cohorts.

      Conclusions

      : Ultrasound abnormalities are not increased in women with DFM compared to controls.

      KEYWORDS

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