Manejo de Disminución de Movimientos Fetales en pacientes del Área de Urgencias Obstétricas / Management of Decreased Fetal Movements in patients in the Obstetric Emergency Area

Los movimientos fetales son uno de los primeros signos de vitalidad fetal. Durante la gestación, éstos van apareciendo progresivamente. La adecuada adquisición y mantenimiento de los mismos durante la gestación indica un correcto desarrollo neuromuscular, así como de bienestar fetal1. La percepción materna de una Disminución de los Movimientos Fetales (DMF) constituye un motivo de consulta frecuente en los Servicios de Urgencias Obstétricas; toda paciente embarazada debe vigilar los movimientos fetales, mediante un conteo subjetivo de los movimientos del feto, a partir de las 24 semanas de gestación. La DMF constituye el 5 ­ 15% de motivos de consulta en los servicios de Urgencias en el tercer trimestre del embarazo. Hasta un 25% de fetos que presentan una DMF presentarán alguna complicación perinatal (malformaciones, retraso de crecimiento, parto prematuro, hemorragia fetomaterna, y éxitus fetal) incluso en población de bajo riesgo. El manejo inadecuado de la DMF representa un 10-15% de las muertes evitables a término1-3. Es por esto que ninguna paciente que consulte por Disminución de Movimientos Fetales debe ser dada de alta sin asegurarse del adecuado bienestar fetal.

Fetal movements are one of the first signs of fetal vitality. During gestation, they appear progressively. Adequate acquisition and maintenance of fetal movements during gestation indicates correct neuromuscular development, as well as fetal well-being1. Maternal perception of decreased fetal movements (DMP) is a frequent reason for consultation in Obstetric Emergency Departments; every pregnant patient should monitor fetal movements by subjectively counting fetal movements, starting at 24 weeks of gestation. FMD constitutes 5-15% of the reasons for consultation in the emergency department in the third trimester of pregnancy. Up to 25% of fetuses with FMD will present some perinatal complication (malformations, growth retardation, premature delivery, fetomaternal hemorrhage, and fetal death) even in low-risk populations. Inadequate management of FMD accounts for 10-15% of preventable deaths at term1-3. This is why no patient who consults for decreased fetal movements should be discharged without ensuring adequate fetal well-being.

The role of non-stress test as a method to evaluate the outcome of high-risk pregnancy: a tertiary care center experience

Background: Non-stress test (NST) is a graphical recording of changes in fetal heart activity and uterine contraction along with fetal movement when uterus is quiescent. NST is primarily a test of fetal condition and it differs from contraction stress test which is a test of uteroplacental function. The present study aimed at evaluating the efficacy and diagnostic value of NST for antenatal surveillance in high-risk pregnancy and comparing the mode of delivery with test results.Methods: A clinical study of NST was done between November 2014 to October 2015. NST was used for their surveillance from 32 weeks of gestation and NST was recorded weekly, biweekly, on alternate days or even on daily basis depending on high risk factors and were followed up.Results: A total of 100 cases were enrolled in the study. The mean age of patients was 25.09±3.78 years. In all 14 cases (23.3%) with reactive NST underwent lower caesarean section (LSCS) whereas 36 cases (90%) with non-reactive NST underwent LSCS. The mean NST delivery interval with reactive NST was 9.8±7.1 hours and in cases with non-reactive NST it was 9.2±8.6 hours, the difference was statistically not significant (p=0.70).Conclusions: NST tells about acute fetal hypoxia and decision to delivery time can be made for those patients with fetal distress so that a major improvement in the outcome among parturient can be achieved with abnormal NST results. An abnormal NST should alert the clinician of fetal compromise and has to be followed up by other biophysical tests.

The Value of Cardiotocography for Evaluation of Fetal Condition and Outcome in Women Presenting with Less Fetal Movement

Objective: In this study our main goal is to determine the valueof cardiotocography for evaluation of fetal condition andoutcome in women presenting with less fetal movement.Method: This cross-sectional study was done at Department ofObstetrics and Gynaecology, Bangabandhu Sheikh MujibMedical University (BSMMU), Dhaka between June 2015 -December 2016. Where women >34 weeks’ gestation withsingleton pregnancies presenting during the study period withmaternal perception of less fetal movement (LFM) in the outpatient Department of Obstetrics and Gynecology in BSMMU.Results: During the study, the mean age was found25.61±5.65 years varied from 19 to 38 years in normal CTGand 24.82±3.81 years varied from 19 to 38 years in abnormalCTG. Majority patients were primiparous in both groups (56.0%vs. 52.0%). More than half (52.0%) of the patients in normalCTG and a half (50.0%) in abnormal CTG patients were camefrom lower middle-income group family. Emergency caesareansection was 12.0% and 42.0% in normal and abnormal CTGrespectively. Emergency caesarean section was significantlyhigher in abnormal CTG. At 1-minute APGAR score £7 wasfound 94.0% babies in normal CTG and 78.0% in abnormalCTG. Needed resuscitation was 4.0% in normal CTG and22.0% in abnormal CTG. Admission to NICU 10.0% babies innormal CTG and 36.0% in abnormal CTG.Conclusions: Decelerations, tachycardia and non-reactive(absent of accelerations) were the more common types ofabnormal CTG. Emergency caesarean section, low APGARscore, needed resuscitation, admission to NICU and prolongedhospital stay were higher in abnormal CTG. CTG can becontinued as a good screening test of fetal surveillance but it isnot the sole criteria to influence the management of high-riskpregnancies.

Prospective study of maternal perception of decreased fetal movement in third trimester and evaluation of its correlation with perinatal compromise

Background: Intrauterine fetal movements are sign of fetal life and well being. Perception of decreased fetal movements by the expecting mother is a common concern for both the mother and her obstetrician. Inadequate evaluation of reported decreased fetal movements may lead to catastrophic perinatal outcome. These necessitates us to identify the mothers perceiving decreased fetal movements, evaluating them to identify any risk factor, and follow up them to know the correlation with perinatal outcome.Methods: Antenatal mothers with singleton pregnancy at third trimester are recruited from OPD/ Emergency of Obstetrics and Gynaecology departments of Teerthankar Mahaveer Medical College and Research Center, Moradabad, Uttar Pradesh, India. Both case and control group comprise of 80 mothers matched by demographic profile, with perception of decreased fetal movements only in case group. They were evaluated thoroughly to identify risk factor if any and were followed up till delivery to know the perinatal outcome.Results: Majority of women reporting reduced fetal movements were between 20-30 years of age group (73%), Primigravida (80%), 72.5% were at term pregnancy. Common (46%) pattern of decreased movements was both in frequency and as well as intensity. 62% women with decreased fetal movements had anteriorly placed placenta.  In the study group, 48.75% women were identified with risk factor, and association of more than one antenatal risk factor was significantly high (p value 0.0026). LBW was more common (21.25%), many neonates were associated with low Apgar score in the study group.Conclusions: Pregnant mothers reported with decreased fetal movement in third trimester should be evaluated adequately for identification of risk factors, as well as for fetal surveillance. Record of fetal movement for 2 hours while the mother is in rest, Cardiotocography, elaborative USG, BPP should be monitored to have good perinatal outcome by providing timely intervention.

Reevaluation of the significance of fetal movement monitoring / 中国实用妇科与产科杂志

Fetal movement counting is one of the common methods for fetal prenatal monitoring. The changes of the normal pattern of fetal movements(FM)indicate abnormal fetal status in uterus.Studies have found that reduced fetal movement is the primary sign of fetal distress,which is associated with adverse pregnancy outcomes such as stillbirth,placental insufficiency,and fetal growth restriction.Increased fetal movement after 32 week's gestation is regular,but a single episode of vigorous FM increases risk of stillbirth.Clinically,fetal safety is preliminarily evaluated by counting numbers of FM to find abnormalities of fetus early and decrease adverse pregnancy outcomes,which is economical,convenient,and simple.However,this method is subjective,due to the different sensitiveness of pregnant women.

Clinical characteristics of pregnancies complicated by congenital myotonic dystrophy

OBJECTIVE: Although the conventional prevalence of myotonic dystrophy is 1:8,000, the prevalence in Korean population was recently reported as 1:1,245. With higher domestic result than expected, we aimed to investigate the clinical characteristics of pregnancies complicated by congenital myotonic dystrophy in our institution. METHODS: We have reviewed 11 paired cases of neonates diagnosed with congenital myotonic dystrophy and their mothers between July 2004 and May 2014, with clinical features including maternal history of infertility, prenatal ultrasonographic findings, and neonatal outcomes. Cytosine-thymine-guanine (CTG) repeat expansion in the myotonic dystrophy protein kinase gene of both neonates and their mothers was also examined. RESULTS: None of mother was aware of their myotonic dystrophy traits before pregnancy. History of infertility followed by assisted reproductive technology accounted for 57.1% (4/7). Distinctive prenatal ultrasonographic finding was severe idiopathic polyhydramnios (66.7%, 4/6) with median amniotic fluid index of 43 (range, 37 to 66). In 37.5% (3/8) cases, decreased fetal movement was evident during prenatal ultrasound examination. For neonatal outcomes, more than half (6/11) were complicated with preterm birth and the proportion of 1-minute Apgar score <4 and 5-minute Apgar score <7 was 44.4% (4/9) and 66.7% (6/9), respectively. Most of neonates were admitted to the neonatal intensive care unit (9/10) because of hypotonia with respiratory problems and there was one infant death. Median number of cytosine-thymine-guanine repeats in mothers and neonates was 400 (range, 166 to 1,000) and 1,300 (range, 700 to 2,000), respectively. CONCLUSION: Our data suggest that severe idiopathic polyhydramnios with decreased fetal movement in pregnant women, especially with a history of infertility, requires differential diagnosis of congenital myotonic dystrophy.

Decreased fetal movements in the third trimester and neonatal hypoxic-ischemic brain damage / 中华实用儿科临床杂志

Fetal movement is one of the markers of fetal wellbeing. Decreased fetal movement(DFM)in the third trimester indicates an increased possibility of intrauterine asphyxia/ anoxia. There is a lack of reported data for the correlation of DFM and incidence of neonatal hypoxic - ischemic brain damage(HIBD). DFM is a multi - factorial clinical phenomenon which may be caused by various issues of pregnant women,fetus,and cord. Incidence of negative neonatal outcomes greatly increased in the condition of DFM. Obstetricians and neonatologists should keep close monito-ring to pregnant women with DFM in the third trimester and their newborn infants. Appropriate medical intervention is highly recommended in order to minimize the occurrence of HIBD.

Responses of term fetuses to different acoustic stimulations / 中华围产医学杂志

Objective To explore the characteristics of fetal movement and FHR variation elicited by acoustic stimulation and whether acoustic stimulation can replace vibroacoustic stimulation. Methods Ninety-four and seventy-six normal pregnant women for antenatal visit were recruited from the Woman's Hospital, School of Medicine, Zhejiang University from April 2002 to February 2003. All subjects were divided into 5 groups to be exposed to five different intensities of acoustic stimulations at 95,100,105,110,115 dB respectively and self-control of blank and vibroacoustic stimulation were designed. The fetal movements and FHR were recorded during the study. Results (1) The percentage of fetal movement evoked by 95,100,105,110,115 dB airborne sound was 15% , 89%, 83% , 83% , 95% respectively. The total percentage of fetal movement evoked by vibroacoustic stimulation was 99% for all subjects. The percentages of evoked fetal movement by 100,105,110,115 dB airborne sound were not significantly different from those by vibroacoustic stimulation. (2)The percentages of FHR acceleration ≥15 bpm in 100,105,110 and 115 dB airborne sound groups were 39%, 61%, 56% and 85%, respectively, while 92% for all cases evoked by vibroacoustic stimulation was significantly higher than those evoked by 100,105 and 110 dB airborne sound group but with no significant difference to 115 dB airborne sound group. (3)The peak value in FHR evoked by 95,100,105, 110 and 115 dB airborne sound were -4. 5 bpm, 12 bpm, 17 bpm, 14 bpm and 20. 5 bpm, respectively. The peak FHR acceleration evoked by vibroacoustic stimulation was 23 bpm which was significantly higher than those by 100,105,110 dB airborne sound and no significant difference was detected between 115 dB airborne sound and vibroacoustic stimulation group. (4)Compared with 115 dB airborne sound, vibroacoustic stimulation evoked significantly longer duration of FHR tachycardia (42. 5 s vs 5 s, P = 0. 011) and fetal movement (270 s vs 100 s, P = 0. 000). Conclusions Acoustic stimulation at 115 dB is able to elicit efficient fetal movement and FHR acceleration without prolonged tachycardia, fetal behavioral disorganization or excessive fetal movement and is reasonable to replace vibroacoustic stimulation for awaking fetuses combined with NST.

The efficacy of rapid biophysical profile for assessment of fetal well-being / 대한산부인과학회잡지

OBJECT: The nonstress test(NST) and complete biophysical profile(BPP) were compared with the rapid biophysical profile(BPP) in order to evaluate the efficacy of the rapid BPP, namely, the combination of amniotic fluid index(AFI) and sound-provoked fetal movement(SPFM) detected by ultrasound, in predicting intrapartum fetal distress in high-risk pregnancies. STUDY DESIGN: From JAN 9th 2000, through JAN 5th 2001, the prospective study of diagnostic tests was conducted on a total of 91 high-risk singleton pregnancies, undergoing antepartum assessment both the standard NST and the new rapid BPP(including other indices of complete BPP). The diagnostic indices of the NST, rapid BPP and complete BPP were calculated in term of predicting intrapartum fetal distress. RESULT: The sensitivity, specificity, negative predictive value, and positive predictive value of NST were 50.00, 94.81, 96.05, and 42.86% respectively, and those of rapid BPP were 75.00, 98.53, 98.53, and 75.00%, and those of complete BPP were 83.33, 98.72, 98.72, and 83.33%, as well. In addition, the efficiency of NST, rapid BPP, and complete BPP were 91.57%, 97.22% and 97.62% respectively. CONCLUSIONS: The rapid BPP is an effective and reliable predictor of intrapartum fetal distress with high-risk pregnancies. Moreover, it may be inexpensive and less time-consuming method.

A Research Of Web-Based Real Time Automatic Fetal Monitoring System / 대한의료정보학회지

In this paper, using ultrasonic doppler signal, we composed fetal heart sound / fetal movement diagnosis and web-based database server/client environment. Detecting fetal heart rate and movement at the same time, for the data loss-caused from telemetering-protection and the high speed diagnosis, we made two signals mix and transmit. For the better communication between obstetrician and remote woman/fetus, we proposed database table that could reflect the whole information about remote fetus and its mom. And we supported HL-7 format so that we might be compatible with other vendor product and easy to access web-based hospital computerization system. Applying doctor to web-based high level biosignal analysis algorithm and expert system, we offered remote fetal biosignal and diagnostic assistant data inducing fast diagnosis. We made web-based fetal diagnostic system and improved web system compatibility, fast diagnosis and minimum of the rate of misdiagnosis.

Development of the Objective Tol for Evaluation of Fetal Movement During Pregnancy / 대한주산의학회잡지

Monitoring fetal movement serves as an indirect rneasure of fetal well-being, especially for central nervous system integrity and function. Methods to monitor fetal movement vary from the simple approach of having the mother chart perceived movement to highly specialized methods. However there were no reliable objective monitoring methods in Korea. For development of objective method for evaluating fetal movement, during pregnancy, one-hundred and two pregnant patients were entered to this study. All patients were divided into following 3 groups and each type of monitoring methods were applied. Group 1(N=20): Type I using portable FHR Doppler unit(IFD-100 model, Intermed, Korea). Group 2(N=20): Type II using FHR Microphone(Prenatal Listening Kit, Model FS002, Unisar Inc., US). Group 3(N=62): Type III using conventional ultrasound transducer(Corometric 115 Model, US). In this study, accurate counting of the fetal movementutus were best performed using Type III, because of monitoring fetal movements has its greatest efficiency when using conventional ultrasound transducer of fetal monitor. It was also attractive to doctors and nurses as a convenient methods because it needed only single transducer when compared to Type I and II. Although monitoring fetal body movement permits a general assessment of well-being, no perfect technique is still reliable. Futher techniques would be developed using the results of this study for improvement of several factors such as accuracy and objectiveness