Assessing in-utero activity
Given that the stillbirth rate in the UK has seen only a small reduction in the last 20 years and that fetal demise is most often preceded by periods of reduced or an absence of fetal movements, it is important to ask ‘how is the assessment of in-utero activity undertaken?’ The evidence suggests that antenatally, women should be regularly asked about their fetal movements and informed on methods of self-assessment. However, there appears to be wide variation in policy and practice, which may be as a result of the lack of consensus as to the definition of reduced fetal movements. As midwives, we offer the majority of care and assessment antenatally and as such have a responsibility for ensuring that women are aware of both the importance of self-assessment of fetal movements and the techniques.
In-utero fetal activity is seen as the hallmark of fetal wellbeing and a vital marker in the routine surveillance of unborn babies, with a further advantage that it can be assessed regularly by the mother with no need for specialist equipment or in patient care (Mangesi and Hofmeyr, 2007). However, there is currently no consensus on what constitutes reduced fetal movements leaving clinicians with limited guidance on definition and, therefore, diagnosis and management (Hofmeyr and Novikova, 2012)
In addition to being a precursor to fetal demise, a reduction in the normal pattern of fetal movements can also be associated with a number of clinical problems including intrauterine growth restriction (IUGR) and, less commonly, fetal abnormalities; in the case of structural conditions, with an anterior placenta (Frøen et al, 2001; O'Sullivan et al, 2009). There is concern that those fetuses at increased risk of stillbirth, who may undergo circulatory adaptations to compensate for reduced utero placental perfusion, may be missed during traditional antenatal surveillance (Alfirevic et al, 2010).
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