Women Can't Count On Fetal Movement Monitoring To Reduce Stillbirth Risk

Because fetal movement is an indicator of an unborn baby's health and decreased movements may signify a problem, pregnant women are often advised to count the number of times they feel their babies kick or move during a prescribed time period.

If the baby is not moving as much as usual, is taking longer to make the same number of movements or has stopped moving, women are advised to call their physician to check the health of the fetus.

Despite the routine use of fetal movement counting in prenatal care, "we cannot be sure that routinely asking pregnant women to count their baby's movements will reduce the risk of adverse outcomes for the baby," said review co-author Dr. G. J. Hofmeyr, head of the obstetrics and gynecology department at the East London Hospital Complex in South Africa.

The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews like this one draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

The review looked at four studies involving 71,370 women from the United States, the United Kingdom, Belgium, Peru and Denmark that compared the outcome of pregnancy when fetal movement counting was done routinely, selectively (for high-risk pregnancies only) or not at all.

After evaluating the data, the authors couldn't confirm that the practice of fetal movement counting had an impact on stillbirth rates.

Only one study in the review was large enough to evaluate stillbirth rates, Hofmeyr said. The study, which included 68,654 women, compared a group of women who routinely monitored fetal movements to women who did so selectively on the advice of a health care provider.

For both groups, "the rate of stillbirths during their trial was considerably less than before the trial," he said. According to Hofmeyr, this suggested, but did not prove, that the attention focused on fetal movement counting during the trial may have benefited both groups of pregnant women.

In another study that compared hospitalization rates, women who counted fetal movements made significantly fewer trips to the hospital before giving birth, compared to women whose hormone levels were monitored with blood tests. Changes in blood hormone levels may indicate problems with fetal health.

However, this finding could not be considered significant, due to the small number of participants.

Overall, the review authors say that "robust research" is needed to evaluate the effect of fetal movement counting on stillbirth rates.

Robin Haynes de Regt, M.D., medical director of Women's and Children's Services at the Evergreen Hospital Medical Center in Kirkland, Wash., said the review fails to "shed light in answering the question of how effective this method of fetal surveillance is."

"It does not tell us if performance of fetal movement counting will reduce the possibility of a stillbirth or bad outcome for the mother or baby. It does not analyze if it is a reasonable trade-off to perhaps increase anxiety if it saves lives," she said.

However, the review does suggest that improved provider education and the "count-to-10" method may offer better monitoring than other counting methods, de Regt said.

One review found that pregnant women preferred and were more likely to comply with the count-to-10 method, in which a woman notes when her fetus moves 10 times during one specific period each day. In other methods, a woman may be asked to count fetal movements after every meal and before bedtime.

de Regt said that women at high risk for pregnancy-related problems may undergo nonstress tests or ultrasound to check fetal movements, but women at low risk do not routinely undergo fetal testing.

"From a physician perspective, [fetal movement monitoring] is the lowest and first form of screening for bad outcome, which many physicians feel is better than no testing at all," de Regt said.

For many pregnant women, fetal movement monitoring is associated with significant feelings of anxiety and worry about the baby's health. To address these concerns, de Regt suggested that pregnant women ask their provider's office to review with them how to perform fetal movement counting so they understand the implications.

"This may improve accuracy and reduce maternal anxiety," she said.

Reference: Mangesi L, Hofmeyr GJ. Fetal movement counting for assessment of fetal wellbeing (Review). Cochrane Database of Systematic Reviews 2007, Issue 1.

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.