Reduced fetal movements in pregnancy: systematic reviews of the evidence and a case-control study of perinatal risk factors and outcomes
Citation:
Carroll, Lorraine, Reduced fetal movements in pregnancy: systematic reviews of the evidence and a case-control study of perinatal risk factors and outcomes, Trinity College Dublin.School of Nursing & Midwifery, 2023Download Item:
FINAL PhD thesis Lorraine Carroll.pdf (PDF) 5.974Mb
Abstract:
Background: The presence of fetal movements (FMs) is regarded as an indicator of fetal
wellbeing during pregnancy. Conversely, maternal perception of reduced fetal
movements (RFM) is considered a potential sign of a fetus at risk of adverse perinatal
outcomes, particularly stillbirth. Early detection of RFM is considered an opportunity for
fetal health screening, thus current clinical guidance encourages women to contact the
maternity hospital for any FM concerns. Preventing and reducing adverse outcomes can
only be achieved through better detection and management of women with RFM.
Pregnancy characteristics of women with RFM however vary across studies.
Aim: The thesis aim was to present an investigation of perinatal risk factors for, and
pregnancy, birth and neonatal outcomes associated with RFM in pregnancy.
Methodology and Methods: A review of the existing literature was conducted to
provide background information on FMs and RFM. A systematic review was also
conducted to synthesise the evidence from non-randomised studies on perinatal risk
factors for and pregnancy, birth and neonatal outcomes in women who presented with
RFM. Subsequently, a case-control study, underpinned by a positivist philosophy, was
chosen as the most appropriate research design to address the study aims and
objectives in the context of maternity care in Ireland. Ethical approval was granted by
the University and Hospital Research Ethics Committees. A prospective case-control
study of women with a singleton pregnancy, presenting to the emergency department,
of a large urban maternity hospital, with a primary complaint of RFM after 24 weeks’
gestation (cases) between 1 January -30 September 2020 were compared with women
who did not have RFM during pregnancy (controls). To provide up to date contemporary
evidence on perinatal risk factors for and outcomes associated with RFM, the systematic
review was updated to include the findings of the prospective case-control study.
Findings: The effectiveness of many strategies to raise awareness of FMs and improve
detection of RFM remains inconclusive. Several maternal characteristics also impact on
maternal perception of FMs, some of which can be classified as risk factors for RFM e.g.,
anterior placenta and obesity. Modifiable (smoking) and non-modifiable (ethnicity, anterior placenta, and abnormalities of amniotic fluid) risk factors for RFM were
identified in the systematic review. Variation in the reporting of risk factors deemed
prominent in contemporary maternity care was emphasised. The association between
RFM and stillbirth was almost 4-fold at increased risk, while babies born small for
gestational age (SGA) were nearly two-fold. The case-control study compared 850
women who presented with RFM with 1743 women who did not present with RFM
during the study period. The rate of women attending with RFM has nearly doubled in
the last two decades. Women with RFM, were more likely to be younger than 35 years,
nulliparous, have a higher mean body mass index and have an anterior positioned
placenta. Women with a history of pregnancy after loss, specifically recurrent
miscarriages or neonatal death were also more likely to attend with RFM during
pregnancy. In contrast to the findings of the systematic review, RFM was not found to
be associated with stillbirth, however, was associated with babies born SGA. Consistent
with numerous studies, women with RFM were more likely to have induction of labour,
although emergency caesarean section was not associated when other factors were
included in the analysis. The updated systematic review identified risk factors for RFM
as nulliparity, women with anterior placenta, assisted conception, a medical history of
psychiatric illness and a previous history of neonatal death. African Black ethnic groups
were less likely to attend for RFM than Asian/Chinese women, including women aged
35 years and over. The risk of stillbirth associated with RFM is declining, though
potentially only in cases where women have increased awareness of FMs and RFM and
is dependent on the timing of assessment for RFM and subsequent clinical management.
Conclusion: Knowledge of maternal characteristics associated with RFM could assist in
identifying pregnancies at higher risk of adverse perinatal outcomes and aid decision
making regarding need for further investigation when a woman presents with RFM
during pregnancy. Contemporary evidence also signifies the groups of women that may
require additional support through information and education on fetal movements. It
also identifies that improvement in the detection of SGA during pregnancy is required.
Description:
APPROVED
Author: Carroll, Lorraine
Advisor:
Smith, ValerieGallagher, Louise
Publisher:
Trinity College Dublin. School of Nursing & Midwifery. Discipline of NursingType of material:
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