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

02 November 2018

Literature Review

02 November 2018

Volume 26 · Issue 11

ISSN (print): 0969-4900

ISSN (online): 2052-4307

Abstract

Background

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.

Aims

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

Methods

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

Findings

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.

Conclusions

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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Fetal movement

Kick charts

Reduced fetal movement

Fetal movement counting

Stillbirth

Perinatal mortality