Abstract

MATERNAL AND NEONATAL OUTCOME IN TERM LOW RISK PREGNANCY WITH REDUCED FETAL MOVEMENT

Hala Adnan Rashed* and Dr. Sundus Yousif Kellow

ABSTRACT

Maternal perception of fetal movement is the most common method to assess fetal wellbeing in most communities today. It performed as unstructured screening to which most pregnant woman depend Significant reduction or sudden alteration in fetal movement is potentially important sign of impending fetal death. Studies of fetal physiology using ultrasound have demonstrated an association between reduced fetal movement and poor perinatal outcome. Aim: To observe the outcome of low risk pregnancies presented with reduced fetal movement at term regarding the time, intrapartum complications, mode of delivery and early neonatal outcome. Design: a prospective case –control study. Methodology: Hundred low risk pregnant women at term were included in the study; fifty of them with reduced fetal movements and the other fifty had good fetal movement. After taking full history and examination including fetal heart rate and non-stress test and sent to ultrasonography for amniotic fluid index and umbilical artery Doppler velocimetry, we followed them up until delivery, and then intrapartum complicated for comparison between the two groups. Results: Regarding mode of delivery there was no significant difference between the two groups, the rate of caesarean section for fetal distress was more among the cases 45.8% than control 29.4%. Number of still birth was just 2 babies of case group. These were significant neonatal complications as birth asphyxia 24% with meconium aspiration syndrome 16%, seizures 10% and early neonatal 6% in the studies (case) groups as compared to the control group. Conclusion: Reduced fetal movement is an important symptom that should be taken seriously and managed accordingly, to reduce perinatal morbidity and mortality. - Each maternity hospital should have a protocol to deal with every pregnant presents with reduced fetal movement. - All clinicians should be aware of the potential association of RFM with risk factores as well as growth restriction, small for GA fetus, placental insufficiency and congenital malformation, those which could be diagnosed by serial examinations during follow up and also by availability of the most up to date and accurate U/S scanning devices in the hospital. - Fetal scalp blood sampling for PH in order to decrease neonatal complications or death.

Keywords: RFM, kick count, Doppler, NST, fetal hypoxia, neonatal outcome.