Fetal movement counting for assessment of fetal wellbeing

BACKGROUND:

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.

OBJECTIVES:

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.

SEARCH STRATEGY:

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 1 October 2009 and added the results to the awaiting classification section.

SELECTION CRITERIA:

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.

MAIN RESULTS:

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.

AUTHORS' CONCLUSIONS:

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.