Background: Stillbirth is a devastating pregnancy outcome with far-reaching economic and psychosocial consequences. Despite significant investment, a screening tool for identifying those fetuses at risk remains elusive. Maternal reporting of decreased feal movements (DFM) has been shown to be associated with stillbirth and other adverse perinatal outcomes. The aim of this study was to examine pregnancy outcomes of women presenting with DFM in the third trimester at a tertiary Australian centre with a clear clinical management algorithm.
Methods: A retrospective cohort study of all singleton, births without a known congenital anomaly, after 28 weeks gestation between 2009-2019 at the Mater Mothers’ Hospital, Brisbane, Australia. Multivariate analysis was undertaken to determine the association between DFM and stillbirth, other adverse outcomes (including small for gestational age (SGA) and a composite adverse perinatal outcome) and obstetric intervention.
Results: 101,597 pregnancies met the inclusion criteria, with 8,821 (8.7%) women presenting at least once with DFM. During this period the stillbirth rate was 2.0 per 1000 births after 28 weeks gestation. DFM did not increase the odds of stillbirth [0.09% vs. 0.16%; aOR 0.54, 95% CI 0.23-1.26, p=0.16]. It was however associated with increased odds of a SGA fetus [aOR 1.14, 95% CI 1.03-1.27] and the composite adverse perinatal outcome [aOR 1.14, 95% CI 1.02-1.27]. DFM was also associated with increased odds of planned early term birth, induction of labour, emergency caesarean.
Interpretation: DFM is a marker of a fetus at risk. The non-significantly lower rate of stillbirth in women with DFM may be reflective of increased community awareness of timely presentation and the benefits of tertiary level care guided by a clear clinical management protocol. However, this is associated with increased odds of birth of a SGA infant, obstetric intervention, early term birth and a composite of adverse perinatal outcomes.