Background Perinatal mortality rate in Scotland is approximately 6.9/1000 births, with a stillbirth rate of 5.1/1000 births.¹ Although the mortality rate has been declining,² this remains a significant problem due to the physical and emotional impact on the woman and her family. Perception of fetal movements (FM) is an important predictor of fetal wellbeing and evidence suggests an association between reduced FM and stillbirth.³

Methods Retrospective case note review of women with stillbirths attending the Simpsons Centre for Reproductive Health (SCRH, Edinburgh) from January–December 2012.

Results 33 women had stillbirths, of which 31 were singletons and 2 were twin pregnancies with a loss of one twin each. The top 3 reasons for attending the maternity unit were reduced FM (48.4%), abdominal pain (19.3%) and incidental finding during monitoring of pre-eclampsia (9.7%). The majority (25.8%) of these women were well antenatally and 19.4% had no identified cause for the stillbirth.

Conclusion Reduced FM was the most common presenting complaint in women with stillbirth. Majority of these women had no antenatal complications prior to presentation but a proportion of them were later found to have evidence of placental insufficiency. In 2013, a new protocol based on the RCOG guidelines⁴ was implemented locally for women presenting with reduced FM which includes fetal monitoring with cardiotocography, ultrasonography for liquor volume and uterine artery Doppler. Patient education was also emphasised. Data for 2013 will be re-audited to assess the outcomes.

References

1. Scottish Perinatal and Infant Mortality and Morbidity Report – Year Ending 31 December 2011”, published on 26 March 2013

2. WHO: Neonatal Mortality Trends 1990 – 2010

3. Efkarpidis S, Alexopoulos E, Kean L, Liu D, Fay T. Case-control Study of Factors Associated with Intrauterine Fetal Deaths. Medscape General Medicine, 2004;6(2):53

4. RCOG Green Top Guideline 57. Reduced Fetal Movements. Published February 2011