Fetal movement counting for assessment of fetal wellbeing
23 June 2014
Findings of the review: Fetal movements are usually considered by mothers as a sign of good health of the baby and counting fetal movements is a common recommendation at prenatal care. This review aimed to: (i) assess whether fetal movement counting (FMC), done routinely or selectively, is effective in improving pregnancy outcomes; and (ii) compare different methods of FMC. Four randomized trials (71 370 women) were included in this review, one of which was a cluster randomized trial (68654 women). All trials evaluated different comparisons. None of them reported blinding, and allocation concealment was detailed in only one study. None of studies compared FMC with no FMC. The cluster randomized trial compared the effect of routine FMC with standard care with some women possibly counting fetal movements in the control groups. One study had compared formal FMC vs. hormonal analysis favouring the control group with significant less hospital visits and fewer neonates with Apgar score less than seven at five minutes. The remaining two studies had compared two different fetal movement counting methods with no statistically significant differences seen for perinatal death or severe morbidity, or other neonatal or maternal outcomes, with the exception of better maternal compliance in the count to-ten method compared with the Cardiff method in one of the studies.
Implementation At the present time there is not enough evidence to either recommend or not recommend selective or routine fetal movement counting to improve outcomes in pregnancy.
Citation: Mangesi L, Hofmeyr GJ, Smith V. Fetal movement counting for assessment of fetal wellbeing. Cochrane Database of Systematic Reviews 2010, Issue 7. Art. No.: CD000110. DOI: 10.1002/14651858.CD000110. pub2. 10.pub22007, Issue 1. Art. No.: CD004909. DOI: 10.1002/14651858.C D004909.pub2
Fetal movement counting is a method by which a woman quantifies the movements she feels to assess the condition of the baby. The purpose is to try to reduce perinatal mortality by alerting caregivers when the baby might have become compromised. This method may be used routinely, or only in women who are considered at increased risk of complications in the baby. Some clinicians believe that fetal movement counting is a good method as it allows the clinician to make appropriate interventions in good time. On the other hand, fetal movement counting may cause anxiety to women.
To assess outcomes of pregnancy where fetal movement counting was done routinely, selectively or was not done at all; and to compare different methods of fetal movement counting.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2006), the Cochrane Central Register of Controlled Trials (The Cochrane Library) and the reference lists of relevant papers. We updated the search of the Cochrane Pregnancy and Childbirth Group's Trials Register on 8 June 2012and added the results to the awaiting classification section.
Randomised controlled trials. Trials were excluded where allocation concealment was inadequate and no measures were taken to prevent bias. The interventions included routine fetal movement counting, selective fetal movement counting, and studies comparing different fetal assessment methods.
Data collection and analysis
We assessed the methodological quality of included studies and extracted data from studies.
Four studies, involving 71,370 women, were included in this review; 68,654 in one cluster-randomised trial. All four trials compared formal fetal movement counting. Two trials compared different types of counting with each other; one with no formal instruction, and one with hormonal analysis. Women in the formal fetal movement counting group had significantly fewer visits to the hospital antenatally than those women randomised to hormone analysis (relative risk (RR) 0.26, 95% confidence interval (CI) 0.20 to 0.35), whereas there were fewer Apgar scores less than seven in five minutes for women randomised to hormone analysis (RR 1.72, 95% CI 1.01 to 2.93).
There was a significantly higher compliance with Cardiff 'count to ten' (once a day) method than the fetal movement counting method where women were counting 30 minutes before meals and at bedtime (more than once a day).
All other outcomes reported were non significant.
This review does not provide enough evidence to influence practice. In particular, no trials compared fetal movement counting with no fetal movement counting. Robust research is needed in this area.
[Note: the four citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.]