When Counting Counts: Maternal Fetal Movement Counts Improve Fetal Distress Recognition

When Counting Counts: Maternal Fetal Movement Counts Improve Fetal Distress Recognition

Fetal movement counts, a simple, inexpensive, and easily accessible tool a mother can use to help monitor the wellbeing of her fetus, have been used to identify potential problems in a timely manner, allowing for prompt interventions. However, the practice has been disputed among health care professionals for lack of conclusive evidence that counting reduces perinatal morbidity and mortality. Now, new research shows that counting has a positive impact.

Eli Saastad, from the faculty of health, nutrition and management at Oslo and Akershus University College of Applied Sciences in Oslo, Norway, and colleagues conducted a multicenter, randomized, controlled trial of 1,076 pregnant women with singleton pregnancies. Starting at gestational week 28, women were randomly assigned to the intervention group, which included fetal movement counting, or the control group, which included standard antenatal care without fetal movement counting. Women in the intervention group received instructions and a brochure on a modified count-to-ten method as well as a fetal movement chart. Two weeks after initiation, the women had access to a midwife or obstetrician to assist them in interpreting the counts.

Saastad and colleagues found that the proportion of growth-restricted fetuses was similar between the two study groups. However, growth-restricted fetuses were more often identified prior to birth in the group that performed counts as opposed to the control group. Similarly, Saastad et al. found fewer adverse outcomes in the intervention group than in the control group. For instance, only 2 (0.4%) babies from the intervention group had Apgar scores <4 at 1 minute as opposed to 12 (2.3%) babies in the control group. The researchers did not find a difference in frequency of consultations due to maternal concern over decreased fetal movements or a statistically significant difference in the frequency of interventions prior to or during delivery between the intervention and control groups.

“This study has suggested that an intervention involving fetal movement counting, compared to no intervention, was associated with improved identification of fetal growth restriction and a reduction in fetuses with severely low Apgar scores – both known to be associated with further adverse neonatal and childhood outcomes,” the authors wrote. “Maternal ability to detect clinically important changes in fetal activity seemed to be improved by fetal movement counting.”


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