- Decreased fetal movement (DFM) is associated with adverse pregnancy outcomes like growth restriction and stillbirth. 42.6% of women who experienced late-term stillbirth reported DFM, compared to 9% of controls. - A large RCT found that asking women to count fetal movements ("count to ten") did not reduce stillbirth rates compared to usual care. However, across the entire cohort, stillbirth rates fell below what was expected. - Several studies found that decreased fetal movement near term, rather than earlier in pregnancy, increases the risk of stillbirth substantially. Women should contact their provider about any concerns of DFM, rather than waiting.

2. Can unborn babies let us know they
are ok?

4. Decreased Fetal Movements
(DFM)
• A quarter of women who present with DFM have adverse
perinatal outcomes such as growth restriction and stillbirth.
(Peat et al 2012)
• 42.6% women who experienced a late term stillbirth
presented with DFMs at some time in their pregnancy
compared to 9% of live born controls. (Stacey et al 2011)

5. Can awareness of fetal movements
be protective against stillbirth?
• Large multi-centred international RCT 68,000 participants
• All risk groups i.e. entire clinics were recruited
• ‘Count to ten’ versus usual care
• No Difference in stillbirth rate between groups
• BUT Stillbirth rate fell , across the cohort , from an expected 4:1000 to 2.8
:1000 ( Grant et al 1989)

6. BUT

7. It is normal to feel less
movement towards the end of
pregnancy

8. • Fetal movements do not normally
decrease close to term. In fact
decreased fetal movement at or near
term places the pregnancy at
substantial increased risk (Dutton et
al 2012, O’Sullivan et al 2009 )

9. Preston et al 2010

10. Recommendation 1 Evidence
level
All Pregnant women should be routinely provided with verbal and written
information regarding normal fetal movements during the antenatal
period.
111-3
Recommendation 2
All women should be advised to contact their health care provider if they
have any concern about decreased or absent fetal movements and be
advised not to wait until the next day to report DFM.
111-3
Recommendation 3
After discussion , women who remain unsure whether movements are
decreased should be given guidance on counting.
However, maternal concern of DFM overrides any definition of DFM based
on numbers of kicks
111-3

11. STARS study

12. STARS
• Online survey
• Cohort study design with nested case-control arm
• Cohort
• A total of 1,714 women who had experienced a stillbirth >3
weeks prior to enrolment completed the survey
• Case-control (preliminary)
• 132 cases who had a stillbirth ≤ 3 weeks prior and 283 controls
who had had a recent livebirth or who were still pregnant.

13. N (%)
N=1,714
No change in fetal movement 480 (28.0%)
A little bit less movement 273 (15.9%)
Significantly less movement 522 (30.5%)
A little bit more movement 136 (7.9%)
Significantly more movement 146 (8.5%)
Don’t remember 103 (6.0%)
Missing 54 (3.2%)
Fetal Movements
46.4%
16.4%
62.8%

14. Increased Movements
.
she was a little more active in the last two weeks
and her pattern was slightly off. Not enough that
I was concerned. I thought it was a healthy sign
The week before my baby passed, I recall she wasVERY active
one night when I was trying to fall asleep, so much that I
actually got up out of bed for a while because her movements
were keeping me awake
The day before he died he
was especially busy and
moving like crazy
moved like crazy then nothing

15. Reduced
n=795 (%)
Increased
n=282 (%)
Did not worry 51 (6.4%) 39 (13.8%)
Mentioned to family and friends but did not worry further 105 (13.2%) 59 (20.9%)
Mentioned to healthcare provider and was reassured 244 (30.7%) 76 (27.0%)
Mentioned to healthcare provider and was told to monitor at
home for symptoms and call back if still concerned
65 (8.1%) 21 (7.4%)
Mentioned to healthcare provider and had general evaluation
(fetal heart rate, cervical status etc)
59 (7.4%) 16 (5.6%)
Mentioned to healthcare provider and outpatient testing 80 (10.1%) 23 (8.1%)
Mentioned to healthcare provider and was admitted 45 (5.7%) 12 (4.5%)
Went to hospital and was admitted 75 (9.4%) 13 (4.6%)
Went to hospital and was sent home 37 (4.7%) 10 (3.5%)
Did not provide response to question 34 (4.3%) 13 (4.6%)
61%

19. Empowering women to know her
baby by asking about FMs:
• Be aware of who her baby is,
• how her baby is and
• Immediately report a change

21. Preston et al 2010

22. Preston 2010