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**13** 

 *Ireland* 

**Reduced Fetal Movements** 

Julia Unterscheider1 and Keelin O'Donoghue2

*1Royal College of Surgeons in Ireland, Rotunda Hospital Dublin,* 

*2Anu Research Centre, University College Cork, Cork University Maternity Hospital,* 

Maternal awareness of fetal movements serves as an indicator of fetal wellbeing and its reduction alerts clinicians to pregnancies at risk of complications. A reduction of fetal movements (FM) causes concern and anxiety, both for the mother and obstetrician, and is a common reason for referral to hospital. Decreased fetal movements affect up to 15% of pregnancies (Sergent *et al*., 2005; Heazell *et al*., 2008). Of those women, 85% are concerned about fetal wellbeing and 53% are afraid that the baby might die (Tveit *et al*., 2006). The perception of reduced movements is highly subjective to the mother and has clinical significance as a predictor of adverse pregnancy outcome - therefore any concerns should be

Conditions associated with diminished fetal movements are summarised in Table 1 and may vary from serious clinical diagnoses such as intrauterine fetal death, intrauterine fetal growth restriction and oligohydramnios, hydrops fetalis and polyhydramnios to other causes such as fetal sleep, anterior placental location, increased body mass index, maternal smoking, metabolic and endocrine disorders or a busy mother who is simply not concentrating on fetal movements. The most common single cause of stillbirth is intrauterine fetal growth restriction (IUGR). Some reports suggest 11-29% of women presenting with reduced FM carry a small for gestational age (SGA) fetus under the 10th centile (Heazell *et al*., 2005; Sinha *et al*., 2007). Sergent *et al*retrospectively reviewed 160 patients complaining of reduced FM and reported 4.3% of fetuses with severe growth restriction in their cohort (Sergent *et al*., 2005). The clinical significance of reduced FM may be unclear until pathological underlying causes have been excluded. Placental dysfunction has been identified as a key factor in pregnancies affected by diminished FM (Warrander *et al*., 2011). There are a wide variety of investigations available, some of which are not proven to be useful in the detection of a fetus at risk or to promote timely intervention. This can lead to unnecessary investigation of otherwise uncomplicated pregnancies, which results in

The Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI) under the umbrella of the National Institute for Clinical Excellence (NICE) collected and analysed data of deaths between 20 weeks gestation and one year of life. In their 8th annual report they reviewed 422 stillbirths and found that 45% of them were associated with suboptimal care; 69 cases (16.4%) were related to altered or reduced fetal movements. Concerns were raised over the

maternal anxiety, inconvenience and increased obstetric intervention.

**1. Introduction** 

taken seriously and assessed appropriately.

