Pregnancy outcome in women perceiving decreased fetal movement

Out of 1914 women who had been instructed to count fetal movements (FMs) throughout the third trimester of pregnancy, 158 consulted the delivery ward staff about decreased FMs; they constituted the study group. Each woman who reported decreased FMs was examined by cardiotocography, analysis of plasma estriol and objective recording of FMs. Appropriate clinical management was decided on by the obstetrician in charge. In 133 (84%) of the 158 women, the results of the fetal examinations proved normal and no intervention was undertaken; in one of these cases the fetus died within 48 h. In two previously uncomplicated pregnancies the maternally perceived decrease in FMs coincided with seriously and persistently abnormal fetal heart rate test results. In both cases caesarean section was carried out within 24 h; the babies had Apgar scores less than or equal to 6 at 1 and 5 min but subsequently developed normally. Babies with congenital malformations (p = 0.001) and small-for-gestational age babies (p = 0.040) were significantly more common among consulters than non-consulters. The fetuses of women who report decreased FMs constitute a risk group and should be carefully monitored; if abnormalities are disclosed there is a potential for improving the fetal outcome by taking appropriate action.