Akselsson A, Georgsson S, Lindgren H, Pettersson K, Rådestad I, Högskola S. Women's attitudes, experiences and compliance concerning the use of Mindfetalness-a method for systematic observation of fetal movements in late pregnancy. BMC Pregnancy Childbirth. 2017; 17:(1)

Guidelines for perinatal care, 7th edn. Washington, DC: AAP and ACOG; 2012

Berbey R, Manduley A, Vigil-De Gracia P. Counting fetal movements as a universal test for fetal wellbeing. Int J Gynaecol Obstet. 2001; 74:(3)293-5

Bhutta ZA, Yakoob MY, Lawn JE Stillbirths: what difference can we make and at what cost?. Lancet. 2011; 377:(9776)1523-38

Bradford B, Maude R. Maternal perception of fetal movements in the third trimester: A qualitative description. Women Birth. 2018; 31:(5)e287-93

Christensen FC, Olson K, Rayburn WF. Cross-over trial comparing maternal acceptance of two fetal movement charts. J Matern Fetal Neonatal Med. 2003; 14:(2)118-22

Delaram M, Shams S. The effect of foetal movement counting on maternal anxiety: A randomised, controlled trial. J Obstet Gynaecol. 2016; 36:(1)39-43

MBRRACE-UK Perinatal Confidential Enquiry: Term, singleton, normally formed, antepartum stillbirth. In: Draper ES, Kurinczuk JJ, Kenyon S (eds). Leicester: The Infant Mortality and Morbidity Studies, Department of Health Sciences, University of Leicester; 2015

Efkarpidis S, Alexopoulos E, Kean L, Liu D, Fay T. Case-control study of factors associated with intrauterine fetal deaths. MedGenMed. 2004; 6:(2)

Flenady V, Middleton P, Smith GC Stillbirths: the way forward in high-income countries. Lancet. 2011; 377:(9778)1703-17

Freda MC, Mikhail M, Mazloom E, Polizzotto R, Damus K, Merkatz I. Fetal movement counting: Which method?. MCN Am J Matern Child Nurs. 1993; 18:(6)314-21

Frøen JF. A kick from within—fetal movement counting and the cancelled progress in antenatal care. J Perinat Med. 2004; 32:(1)13-24

Frøen JF, Heazell AEP, Tveit JVH, Saastad E, Fretts RC, Flenady V. Fetal movement assessment. Semin Perinatol. 2008; 32:(4)243-6

Frøen JF, Cacciatore J, McClure EM Stillbirths: why they matter. Lancet. 2011; 377:(9774)1353-66

Frøen JF, Friberg IK, Lawn JE Stillbirths: progress and unfinished business. Lancet. 2016; 387:(10018)574-86

Gilchrist L. Assessing in-utero activity. Br J Midwifery. 2015; 23:(6)406-11

Goldenberg RL, McClure EM, Bhutta ZA Stillbirths: the vision for 2020. Lancet. 2011; 377:(9779)1798-805

Gómez LM, De la Vega G, Padilla L, Bautista F, Villar A. Compliance with a fetal movement chart by high-risk obstetric patients in a Peruvian hospital. Am J Perinatol. 2007; 24:(2)89-93

Grant A, Elbourne D, Valentin L, Alexander S. Routine formal fetal movement counting and risk of antepartum late death in normally formed singletons. Lancet. 1989; 2:(8659)345-9

Harper RG, Greenberg M, Farahani G, Glassman I, Kierney CM. Fetal movement, biochemical and biophysical parameters, and the outcome of pregnancy. Am J Obstet Gynecol. 1981; 141:(1)39-42

Haws RA, Yakoob MY, Soomro T, Menezes EV, Darmstadt GL, Bhutta ZA. Reducing stillbirths: screening and monitoring during pregnancy and labour. BMC Pregnancy Childbirth. 2009; 9:(1)

Investigation and management of late fetal intrauterine death and stillbirth.Dublin: HSE; 2011

Perinatal statistics report 2015.Dublin: HSE; 2017

Heazell AEP, Frøen JF. Methods of fetal movement counting and the detection of fetal compromise. J Obstet Gynaecol. 2008; 28:(2)147-54

Heazell AEP, Stacey T, O'Brien LM, Mitchell EA, Warland J. Excessive fetal movements are a sign of fetal compromise which merits further examination. Med Hypotheses. 2018; 111:19-23

Kamalifard M, Abbasalizadeh S, Ghojazadeh M, Ghatreh Samani F, Rabiei L. Diagnostic value of fetal movement counting by mother and the optimal recording duration. J Caring Sci. 2013; 2:(2)89-95

Lawn JE, Blencowe H, Waiswa P Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet. 2016; 387:(10018)587-603

Leader LR, Baillie P, Van Schalkwyk DJ. Fetal movements and fetal outcome: a prospective study. Obstet Gynecol. 1981; 57:(4)431-6

Linde A, Pettersson K, Rådestad I. Women's experiences of fetal movements before the confirmation of fetal death – Contractions misinterpreted as fetal movement. Birth. 2015; 42:(2)189-94

Liston RM, Bloom K, Zimmer P. The psychological effects of counting fetal movements. Birth. 1994; 21:(3)135-40

Lobb MO, Beazley JM, Haddad NG. A controlled study of daily fetal movement counts in the prevention of stillbirths. Journal of Obstetrics and Gynaecology. 1985; 6:(2)87-91

Mangesi L, Hofmeyr GJ, Smith V, Smyth RMD. Fetal movement counting for assessment of fetal wellbeing. Cochrane Database Syst Rev. 2015; (10)

Manning E, Corcoran P, Meaney S, Greene RA. Perinatal mortality in Ireland: annual report 2013.Cork: National Perinatal Epidemiology Centre; 2015

McArdle A, Flenady V, Toohill J, Gamble J, Creedy D. How pregnant women learn about foetal movements: sources and preferences for information. Women Birth. 2015; 28:(1)54-9

Moore TR, Piacquadio K. A prospective evaluation of fetal movement screening to reduce the incidence of antepartum fetal death. Am J Obstet Gynecol. 1989; 160:1075-80

Antenatal care: Routine care for the healthy pregnant woman.London: NICE; 2008

Neldam S. Fetal movements as an indicator of fetal wellbeing. Lancet. 1980; 1:(8180)1222-4

Pakenham S, Copeland A, Farine D. Kick-starting action: Canadian women's understanding of fetal movement guidelines. J Obstet Gynaecol Can. 2013; 35:(2)111-18

Pearson JF, Weaver JB. Fetal activity and fetal wellbeing: an evaluation. Br Med J. 1976; 1:(6021)1305-7

Polit DF, Beck CT. Essentials of nursing research: Appraising evidence for nursing practice, 8th edn. Philadelphia (PA): Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014

Rådestad I. Fetal movements in the third trimester—Important information about wellbeing of the fetus. Sex Reprod Healthc. 2010; 1:(4)119-21

Rayburn WF. Fetal Movement Monitoring. Clinical Obstetrics and Gynecology. 1995; 38:(1)59-67

Reduced fetal movements.Manchester: RCOG; 2011

Saastad E, Tveit JVH, Flenady V Implementation of uniform information on fetal movement in a Norwegian population reduced delayed reporting of decreased fetal movement and stillbirths in primiparous women - a clinical quality improvement. BMC Res Notes. 2010; 3:(1)

Saastad E, Israel P, Ahlborg T, Gunnes N, Frøen JF. Fetal movement counting—effects on maternal-fetal attachment: a multicenter randomized controlled trial. Birth. 2011a; 38:(4)282-93

Saastad E, Winje BA, Stray Pedersen B, Frøen JF. Fetal movement counting improved identification of fetal growth restriction and perinatal outcomes—a multi-centre, randomized, controlled trial. PLoS One. 2011b; 6:(12)

Saastad E, Winje BA, Israel P, Frøen JF. Fetal movement counting—maternal concern and experiences: a multicenter, randomized, controlled trial. Birth. 2012; 39:(1)10-20

Sadovsky E, Polishuk WZ. Fetal movements in utero: nature, assessment, prognostic value, timing of delivery. Obstet Gynecol. 1977; 50:(1)49-55

Smith V, Begley C, Devane D. Detection and management of decreased fetal movements in Ireland: a national survey of midwives' and obstetricians' practices. Midwifery. 2014; 30:(1)43-9

Stacey T, Thompson JMD, Mitchell EA, Ekeroma A, Zuccollo J, McCowan LME. Maternal perception of fetal activity and late stillbirth risk: findings from the Auckland Stillbirth Study. Birth. 2011; 38:(4)311-16

Fetal health surveillance: Antepartum and intrapartum consensus guideline.Ontario: SOGC; 2007

Tveit JVH, Saastad E, Stray-Pedersen B Reduction of late stillbirth with the introduction of fetal movement information and guidelines - a clinical quality improvement. BMC Pregnancy Childbirth. 2009; 9:(1)

Tveit JVH, Saastad E, Stray-Pedersen B Correction: reduction of late stillbirth with the introduction of fetal movement information and guidelines - a clinical quality improvement. BMC Pregnancy Childbirth. 2010; 10:(1)

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 Republic of Ireland. J Obstet Gynaecol. 2010; 30:(6)578-82

Velazquez MD, Rayburn WF. Antenatal evaluation of the fetus using fetal movement monitoring. Clin Obstet Gynecol. 2002; 45:(4)993-1004

Warland J, O'Brien LM, Heazell AE, Mitchell EA An international internet survey of the experiences of 1,714 mothers with a late stillbirth: the STARS cohort study. BMC Pregnancy Childbirth. 2015; 15:(1)172-81

Warland J, Glover P. Fetal movements: what are we telling women?. Women Birth. 2017; 30:(1)23-8

Wells G, Shea B, Higgins JPT, Sterne J, Tugwell P, Reeves BC. Checklists of methodological issues for review authors to consider when including non-randomized studies in systematic reviews. Res Synth Methods. 2013; 4:63-77

Westgate J, Jamieson M. Stillbirths and fetal movements. N Z Med J. 1986; 99:(796)114-16

Winje BA, Saastad E, Gunnes N Analysis of ‘count-to-ten’ fetal movement charts: a prospective cohort study. BJOG. 2011; 118:(10)1229-38

Winje BA, Røislien J, Frøen JF. Temporal patterns in count-to-ten fetal movement charts and their associations with pregnancy characteristics: a prospective cohort study. BMC Pregnancy Childbirth. 2012; 12:(1)124-35

Winje BA, Wojcieszek AM, Gonzalez-Angulo LY Interventions to enhance maternal awareness of decreased fetal movement: a systematic review. BJOG. 2016; 123:(6)886-98

The role of fetal movement counting and ‘kick charts’ to reduce stillbirths in pregnancies ≥28 weeks’ gestation

02 November 2018
Volume 26 · Issue 11



Stillbirths represent a significant global issue, with 2.6 million cases reported in 2015. Stillbirths are often unexplained and preceded by changes in fetal movement patterns. Fetal movement counting methods may be used to monitor maternally perceived fetal movement to identify pregnancies at increased risk.


This article reports on an in-depth, evidence-based practice review conducted to investigate the relationship between fetal movement counting and stillbirth rates.


A comprehensive search of online databases was undertaken to identify relevant literature using keywords. The results were then appraised.


Although a lack of conclusive evidence exists to support or refute the routine implementation of fetal movement counting to reduce stillbirth, indirect evidence suggests that increased maternal and professional awareness of fetal movement may assist in reducing stillbirth rates.


Further research is required to develop an appropriate definition of reduced fetal movement, and to determine the potential implications of fetal movement counting as a diagnostic screening tool to reduce stillbirths.

Despite advances in maternity care internationally, stillbirths remain a significant global issue (Frøen et al, 2011) with approximately 2.6 million cases reported in 2015 (Lawn et al, 2016). In Ireland, stillbirth is defined as a baby born without signs of life beyond 23+6 weeks' gestation or with a birthweight ≥500g (Health Service Executive (HSE), 2011; Manning et al, 2015). This accounted for approximately 1/250 births in 2015, representing a stillbirth rate of 4.0/1000 births (HSE, 2017). Reports demonstrate that stillbirths frequently occur in low-risk pregnancies (Warland et al, 2015), and an estimated 30% occur after 37 weeks' gestation (Gilchrist, 2015), while approximately 50% of all stillbirths are unexplained (Draper et al, 2015). The significance of this issue must therefore be addressed. Stillbirth prevention has emerged as a leading research priority internationally (Goldenberg et al, 2011; Frøen et al, 2016).

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