Background RFM is associated with increased risk of stillbirth and small for gestational age babies.^1,2 Notwithstanding the Royal College of Obstetricians and Gynaecologists’ guidelines, clinical practice varies due to individual circumstances and decisions regarding delivery are often at the discretion of the obstetrician.³

Aim To analyse the investigations, management and outcomes of women presenting to antenatal services in Leeds Teaching Hospitals Trust (LTHT) with RFM at term.

Objective To assess whether the management was in accordance with LTHT guidelines and suggest recommendations to improve practice.

Methods Demographic details, investigations, management and outcome in 145 cases were analysed from medical records.

Results 144 women had a cardiotocography (CTG). In women presenting twice or more with RFM after 37 weeks, induction of labour was more common (62.2%) than in women presenting once (13.0%). In four cases, ultrasound investigation was arranged after only one presentation and despite a normal CTG; which is not in accordance with guidelines. Ultrasound was not standardised. The rate of instrumental deliveries (13.10%) was higher than the LTHT average (9.03%). One baby was growth restricted but no intrauterine deaths were recorded.

Conclusions Patients presenting with RFM are more likely to be induced especially if they present more than once. This was associated with a higher rate of instrumental delivery but not LSCS. Guidelines were not always followed, suggesting that they should be incorporated into training more effectively. All women presenting with RFM should have a CTG, and ultrasound scans should be standardised to include dopplers and BPP.

References

1. Sinha D, Sharma A, Nallaswamy V, Jayagopal N, Bhatti N. Obstetric outcome in women complaining of reduced fetal movements. Journal of Obstetrics and Gynaecology 2007;27(1):41–43

2. Heazell AEP, Green M, Wright C, Flenady V, Froen JF. Midwives’ and obstetricians’ knowledge and management of women presenting with decreased fetal movements. Acta Obstetrica Et Gynecologica Scandinavica 2008;87(3):331–39

3. Unterscheider J, Horgan RP, Greene RA, Higgins JR. The management of reduced fetal movements in an uncomplicated pregnancy at term: Results from an anonymous national online survey in the ROI. Journal of Obstetrics and Gynaecology 2010;30(6):578–81