Fetal movement counting at home with a fetal movement acceleration measurement recorder: A preliminary report

Objective: Fetal Movement Acceleration Measurement (FMAM) recorder was developed to facilitate gross fetal movement counting. The aim was to assess its reliability. Methods: Using the recorder, six pregnant women recorded fetal movements by themselves when they slept at their home weekly from 30 weeks to term. The recorder has 2 acceleration sensors; 1 for fetal movement (FM sensor) and another for maternal movement (MM sensor). Before sleeping, each subject attached the FM sensor to her abdomen, and the MM sensor to her thigh. All the recorded data were divided into 10-sec epochs, and presence of fetal movements was judged for all epochs (total epoch). The epoch was judged as positive for movement (positive epoch) when the FM sensor detected abdominal wall oscillations and the MM sensor did not detect maternal movements. The percentage of positive epoch number to total epoch and the maximum consecutive negative epoch number was calculated. Results: The mean percentage was approximately 20–25% at 30–34 weeks and 10–15% at 35–38 weeks. The negative epoch number linearly increased after approximately 33–34 weeks of gestation. Conclusions: The FMAM recorder was reliable for long-duration recording of gross fetal movements at home.     

Fetal movement detection: Comparison of the toitu actograph with ultrasound from 20 weeks gestation

Objective: This study evaluates the validity of Doppler-detected fetal movement by a commercially available monitor and investigates whether characteristics of maternal body habitus and the intrauterine environment affect its performance.

Methods: Fetal movement was evaluated in normal pregnancies using both ultrasound visualization and a fetal actocardiograph (Toitu MT320; Tofa Medical Inc., Malvem, PA). Data were collected for 32 min on 34 fetuses stratified by gestational age (20–25 weeks; 28–32 weeks; 35–39 weeks). Fetal and maternal characteristics were recorded. Comparisons between ultrasound-detected trunk and limb movements and actograph records were conducted based both on 10-s time intervals and on detection of individual movements.

Results: Time-based comparisons indicated agreement between ultrasound and actograph 94.7% of the time; this association rose to 98% when movements of less than 1 s duration were excluded. Individual movements observed on ultrasound were detected by the actograph 91% of the time, and 97% of the time when brief, isolated movements were excluded. The overall kappa value for agreement was 0.88. The actograph was reliable in detecting periods of quiescence as well as activity. These findings did not vary by gestational age. The number of movements detected by the actograph, but not the single-transducer ultrasound, significantly increased over gestation. Maternal age, parity, weight, height, or body mass index were not consistently associated with actograph validity. Characteristics of the uterine environment, including placenta location, fetal presentation, and amniotic fluid volume also did not affect results.

Conclusions: The Toitu actograph accurately detects fetal movement and quiescence from as early as 20 weeks gestation and has utility in both clinical and research settings. Actographs are most useful for providing objective and quantifiable measures of fetal activity level, including number and duration of movements, while visualization through ultrasound is necessary for studies of movement quality, source, or mechanics.     

Detection and management of decreased fetal movements in Australia and New Zealand: A survey of obstetric practice

Background:  Decreased fetal movement (DFM) is associated with increased risk of adverse pregnancy outcome. However, there is limited research to inform practice in the detection and management of DFM.
Aims:  To identify current practices and views of obstetricians in Australia and New Zealand regarding DFM.
Methods:  A postal survey of Fellows and Members, and obstetric trainees of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
Results:  Of the 1700 surveys distributed, 1066 (63%) were returned, of these, 805 (76% of responders) were currently practising and included in the analysis. The majority considered that asking women about fetal movement should be a part of routine care. Sixty per cent reported maternal perception of DFM for 12 h was sufficient evidence of DFM and 77% DFM for 24 h. KICK charts were used routinely by 39%, increasing to 66% following an episode of DFM. Alarm limits varied, the most commonly reported was < 10 movements in 12 h (74%). Only 6% agreed with the internationally recommended definition of < 10 movements in two hours. Interventions for DFM varied, while 81% would routinely undertake a cardiotocograph, 20% would routinely perform ultrasound and 20% more frequent antenatal visits.
Conclusions:  While monitoring fetal movement is an important part of antenatal care in Australia and New Zealand, variation in obstetric practice for DFM is evident. Large-scale randomised controlled trials are required to identify optimal screening and management options. In the interim, high quality clinical practice guidelines using the best available advice are needed to enhance consistency in practice including advice provided to women.     

胎儿生长受限与死胎

死胎的发生与胎儿生长受限(FGR)有关。FGR是死胎发生的重要原因之一,两者病因和发病危险因素相似。但发生FGR因素复杂而非单一。识别FGR潜在的危险因素及早期发现、早期诊断、早期干预是降低各类因素FGR发生死胎的关键。     

胎动监测意义的再评估

胎动计数是常用的胎儿产前监测方法之一,胎动正常模式的改变预示着胎儿宫内状态异常。研究发现,胎动减少常是胎儿窘迫的首要征象,与死胎、胎盘功能不全、胎儿生长受限等不良妊娠结局相关;妊娠32周后胎动增加是正常的胎动规律,但单次过度运动与死胎有关。临床上通过孕妇自数胎动的方式初步评估胎儿宫内安危以便早期发现胎儿异常,减少不良妊娠结局的发生,这种方法具有经济、方便、简单、能反映部分问题的特点,但是较为主观,孕妇个体感受的胎动差异较大。     

Maternal Perception of Fetal Activity and Late Stillbirth Risk: Findings from the Auckland Stillbirth Study

Abstract: Background: Maternal perception of decreased fetal movements has been associated with adverse pregnancy outcomes, including stillbirth. Little is known about other aspects of perceived fetal activity. The objective of this study was to explore the relationship between maternal perception of fetal activity and late stillbirth (≥ 28 wk gestation) risk. Methods: Participants were women with a singleton, late stillbirth without congenital abnormality, born between July 2006 and June 2009 in Auckland, New Zealand. Two control women with ongoing pregnancies were randomly selected at the same gestation at which the stillbirth occurred. Detailed demographic and fetal movement data were collected by way of interview in the first few weeks after the stillbirth, or at the equivalent gestation for control women. Results: A total of 155/215 (72%) women who experienced a stillbirth and 310/429 (72%) control group women consented to participate in the study. Maternal perception of increased strength and frequency of fetal movements, fetal hiccups, and frequent vigorous fetal activity were all associated with a reduced risk of late stillbirth. In contrast, perception of decreased strength of fetal movement was associated with a more than twofold increased risk of late stillbirth (aOR: 2.37; 95% CI: 1.29–4.35). A single episode of vigorous fetal activity was associated with an almost sevenfold increase in late stillbirth risk (aOR: 6.81; 95% CI: 3.01–15.41) compared with no unusually vigorous activity. Conclusions: Our study suggests that maternal perception of increasing fetal activity throughout the last 3 months of pregnancy is a sign of fetal well‐being, whereas perception of reduced fetal movements is associated with increased risk of late stillbirth. (BIRTH 38:4 December 2011)     

Fetal Movement Counting—Effects on Maternal‐Fetal Attachment: A Multicenter Randomized Controlled Trial

Abstract: Background: Women presenting with decreased fetal movement have an increased risk of adverse pregnancy outcomes. Fetal movement counting may be associated with improvement in maternal‐fetal attachment, which in turn, improves pregnancy outcome and postnatal mother–infant attachment. The study aim was to test whether maternal‐fetal attachment differed between groups of mothers who systematically performed fetal movement counting and mothers who followed standard antenatal care where routine fetal movement counting was discouraged. Methods: In a multicenter, randomized trial, 1,123 women were assigned to either systematic fetal movement counting from pregnancy week 28 or to standard antenatal care. This study sample included primarily white, cohabiting, nonsmoking, and relatively well‐educated women. The outcome measure was maternal‐fetal attachment, measured by using the Prenatal Attachment Inventory. Analysis was by intention‐to‐treat. Results: No difference was found between the groups in the scores on prenatal attachment; the means and standard deviations were 59.54 (9.39) and 59.43 (9.35) for the intervention and the control groups, respectively (p = 0.747). The mean difference between the groups was 0.20 (95% CI: 1.02–1.42). Conclusions: Fetal movement counting in the third trimester does not stimulate antenatal maternal‐fetal attachment. This result differs from a previous study where fetal movement counting improved maternal‐fetal attachment. Further research with a focus on possible mediating factors such as levels of stress, concern, and other psychological factors is required. (BIRTH 38:4 December 2011)     

Fetal loss from umbilical cord abnormalities--a difficult case for prevention

The summaries of 12 pregnancies in which fetal distress and death were thought to be the result of umbilical cord abnormalities are presented. These included six cases of stricture and torsion of the cord, one case of umbilical vein aneurysm, one case of perivascular haemorrhage near the fetal end of the cord, one case of umbilical vein thrombosis, two cases of true knot of the cord and one case of very short cord. The perinatal mortality was 75% in the whole group (9 out of 12 fetuses), there being eight stillbirths and one neonatal death. Of the 12 fetuses, only three were small for dates at delivery. Nine patients volunteered the history of a decrease in fetal movements, and non-stress cardiotocography (NST) was abnormal in eight patients. It was noted, however, that fetal death tended to occur rapidly after an abnormal test. Observations in our series indicated that antepartum fetal deaths due to umbilical cord abnormalities are still difficult to prevent, as it is often impossible to detect fetal distress in time for appropriate intervention. Prompt action to deliver the baby after an abnormal NST appears to be a necessary step to prevent antepartum deaths due to such causes.     

胎儿血氧饱和度监测的临床应用

胎儿脉冲血氧测定(fetal pulse oximetry,FPO)可提高产程中对胎儿健康状况评估的准确性。现有随机对照临床试验结果显示,它可以降低胎心宫缩监护(CTG)提示不确定胎儿情况的剖宫产率,但不会降低总体剖宫产率。     

产科医师需关注死胎问题

<正>孕产妇死亡率(maternal mortality rate,MMR)与围产儿死亡率(perinatal mortality rate,PMR)可衡量一个国家、一个地区综合发展指标,一直受到各国的高度重视。近年来,孕产妇死亡率以及小于5岁以下婴幼儿死亡率已经有了较大程度的降低,但反映全球产科质量的指标——死胎,其发生率未见明显下降,每年有260万例死胎(intrauter-ine fetal death,IUFD)~([1-2]),是导致孕产妇焦虑、抑     

Decision-to-Delivery Interval After Implementation of a Specific Protocol for Emergency Cesarean Delivery Because of Category III Fetal Heart Rate Tracings

ObjectiveTo assess the frequency of emergency cesarean deliveries with decision-to-delivery intervals (DDIs) of less than 30 minutes after implementation of a code blue protocol following National Institute of Child Health and Human Development (NICHD) category III fetal heart rate (FHR) tracings. The secondary aim was to compare differences in pregnancy outcomes for deliveries completed before and after the 30-minute threshold.MethodsAll women undergoing a code blue emergency cesarean delivery between July 2015 and December 2021 were included. Information from electronic medical records, including baseline demographics, clinical characteristics, and pregnancy outcomes were retrospectively reviewed.ResultsAmong 254 code blue cesarean deliveries, 246 (96.9%) had a DDI of ≤30 minutes. The median DDI was 17 (14.3–20.0) minutes. No significant differences in adverse maternal and neonatal outcomes were detected between deliveries with DDIs greater than and less than 30 minutes. The incidence of stillbirth was higher in the >30 minute-DDI group than in the ≤30 minute-DDI group (12.5% vs. 2%; P = 0.176).ConclusionsAfter implementation of a code blue protocol for emergency cesarean delivery, a DDI within 30 minutes was achieved in 97% of cases with category III FHR tracings. The incidence of stillbirth was dramatically higher in the >30 minutes-DDI group. We encourage all obstetric units to consider every factor that could reduce the DDI by developing specific, local protocols.     

Fetal electrocardiography: feasibility of long-term fetal heart rate recordings

The feasibility and accuracy of long-term transabdominal fetal electrocardiogram (fECG) recordings throughout pregnancy were studied using a portable fECG monitor. Fifteen-hour recordings of fetal heart rate (FHR) were performed in 150 pregnant women at 20–40 weeks of gestation and 1-hour recordings were performed in 22 women in labour and compared with simultaneous scalp electrode recordings. When ≥60% of fECG signals was present, the recording was defined as good. Eighty-two percent (123/150) of antenatal recordings were of good quality. This percentage increased to 90.7 (136/150 recordings) when only the night part (11 p.m.–7 a.m.) was considered. Transabdominal measurement of FHR and its variability correlated well with scalp electrode recordings ( r = 0.99, P < 0.01; r = 0.79, P < 0.01, respectively). We demonstrated the feasibility and accuracy of long-term transabdominal fECG monitoring.     

Fetal monitoring by physical methods I.Technical questions

Several methods to record fetal heart signals and uterine activity simultaneously are available. Almost any of these methods presents certain technical questions based on the different nature and properties of the signals. The significance of these questions for the data obtained during fetal monitoring by physical methods is discussed.     

Fetal extrasystole may predict poor neonatal outcome

Extrasystoles particularly premature atrial contractions noted during labour on the fetal heart rate monitoring strip are usually thought to be benign. In pregnancies complicated by fetal infection and/or the fetal inflammatory response syndrome, there are some data that extrasystoles noted during the intrapartum period may be related to neonatal sepsis and eventual poor neonatal outcome including death or neonatal encephalopathy. Additional observations are needed to substantiate this hypothesis.     

Fetal monitoring by physical methods II. Interpretation of phenomena

The results of assessing the fetal condition by means of the fetal electrocardiogram or the fetal heart rate pattern are by no means consistent. In the case of the fetal electrocardiogram this is due to several factors, such as lack of a standard lead, changes in the topographical relationship between the electrodes and the fetal heart caused by fetal movements, and incomplete knowledge about the direction of the fetal heart axis. The phenomena in the fetal heart rate pattern by which the fetal condition is assessed are insufficiently defined. Moreover, the physiologie mechanisms involved in the generation of the fetal heart rate pattern are, until now, not well understood.     

Maternal perception of fetal movements in late pregnancy is affected by type and duration of fetal movement

Objective: A reduction in fetal movements has been proposed to identify pregnancies at risk of stillbirth. The utility of this approach is limited by variability in maternal perception of fetal movements. We aimed to determine the proportion of fetal movements observed by ultrasound that were maternally perceived and identify factors that affected maternal perception.

Method: During 30-min recordings, women (n = 21) depressed a trigger upon perception of a fetal movement, while an ultrasound operator recorded observed movements according to the fetal parts involved.

Results: Women perceived between 2.4% and 81.0% (median 44.8%) of movements observed on scan. Synchronous movement of the fetal trunk and limbs was more likely to be recognized than either part in isolation (60.5% versus 37.5% and 30%, respectively). The ultrasound operator judged the fetus to be moving for a significantly greater proportion of the time than mothers (median 1.5% of total recording time versus 0.7%). There was no significant relationship between the ability to perceive fetal activity and placental site, parity, amniotic fluid index or maternal body mass index.

Conclusion: Variations in maternal perception of fetal movements may affect detection of a clinically significant reduction in fetal movements for some women.     

Fetal heart rate response to cordocentesis and pregnancy outcome: A prospective cohort

Objective.?To evaluate fetal cardiac response to cordocentesis and whether such changes may affect pregnancy outcome.

Methods.?117 singleton pregnant women requiring percutaneous trans-abdominal cordocentesis were prospectively included. Fetal heart rate was continuously evaluated by ultrasound for 1?min after completion of cordocentesis and intermittently for 20?min more. Fetal and pregnancy outcomes were analyzed by grouping fetal cardiac response to cordocentesis into bradycardia, normal heart rate and tachycardia groups.

Results.?Women included in the study were 30.5?±?4.0 years old and had a gestational age of 23.7?±?2.0 weeks. Fetal blood sample obtained by cordocentesis was 3.1?±?0.8?ml. Fetal heart rate before cordocentesis was 149?±?8 beats per minute (bpm), ranging from 130 to 169 bpm. Fetal heart rate post-cordocentesis was 145?±?30 bpm (from 32 to 175 bpm). The incidence of bradycardia and tachycardia was 10.3% (n?= 12) and 6.0% (n?= 7), respectively. Fetal heart rate returned to normal levels in all cases at ??5 minutes post-cordocentesis. In the tachycardia group, 6 cases had normal pregnancy outcome and one patient was lost to follow-up. In the bradycardia group, we observed two pregnancy terminations, one patient was lost to follow-up and nine were normal outcomes. In the group with normal heart rate (n?=?98), we observed one intrauterine fetal death, nine adverse fetal outcomes, eight pregnancy terminations and nine patients were lost to follow-up.

Conclusions.?Transient fetal tachycardia and bradycardia were uncommon and were not associated with adverse fetal or pregnancy outcomes.