Irene Sterpu1,2, Christina Pilo2, Ina Schuppe Koistinen3, Pelle G Lindqvist1,2, Kristina Gemzell-Danielsson4, Eva Wiberg Itzel1,2. 1. Department of Clinical Science and Education, Karolinska Institutet, Soder Hospital, Stockholm, Sweden. 2. Department of Obstetrics and Gynecology, Soder Hospital, Stockholm, Sweden. 3. Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden. 4. Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
Abstract
INTRODUCTION: The incidence of Swedish stillbirths has varied little in the past 40 years, with a reported frequency of 400-450 stillbirths/year (approximately 4‰), despite increased information about fetal movement in the media and awareness among health care providers. The objectives of this project were to describe the outcome of pregnancies with reduced fetal movement in a Swedish context and to investigate factors associated with poor neonatal outcome in this group. MATERIAL AND METHODS: A retrospective cohort study was performed at Soder Hospital, Stockholm, Sweden. All single pregnancies at the hospital from January 2016 to December 2017 presenting with reduced fetal movement after 22 gestational weeks were included in the study. A composite neonatal outcome was constructed: 5-min Apgar score ≤ 7, arterial pH in the umbilical cord ≤ 7.10, transfer to neonatal care unit for further care, or intrauterine fetal death. RESULTS: For women seeking care for reduced fetal movement, the occurrence of composite poor neonatal outcome ranged from 6.2% to 18.4% within different groups. The highest risk for poor neonatal outcome (18.4%) was found in the group of women with a small for gestational age fetus. Another high-risk group (12.8%) was the one of women with normal birthweight/large for gestational fetuses with an in vitro fertilization pregnancy. CONCLUSIONS: The highest incidence of poor neonatal outcome among women with reduced fetal movement was found in the groups with small for gestational age fetuses in nulliparous and multiparous women. A routine ultrasound assessment for fetal growth in third trimester is supposedly most efficient to identify undiagnosed small for gestational age. This article is protected by copyright. All rights reserved.
INTRODUCTION: The incidence of Swedish stillbirths has varied little in the past 40 years, with a reported frequency of 400-450 stillbirths/year (approximately 4‰), despite increased information about fetal movement in the media and awareness among health care providers. The objectives of this project were to describe the outcome of pregnancies with reduced fetal movement in a Swedish context and to investigate factors associated with poor neonatal outcome in this group. MATERIAL AND METHODS: A retrospective cohort study was performed at Soder Hospital, Stockholm, Sweden. All single pregnancies at the hospital from January 2016 to December 2017 presenting with reduced fetal movement after 22 gestational weeks were included in the study. A composite neonatal outcome was constructed: 5-min Apgar score ≤ 7, arterial pH in the umbilical cord ≤ 7.10, transfer to neonatal care unit for further care, or intrauterine fetal death. RESULTS: For women seeking care for reduced fetal movement, the occurrence of composite poor neonatal outcome ranged from 6.2% to 18.4% within different groups. The highest risk for poor neonatal outcome (18.4%) was found in the group of women with a small for gestational age fetus. Another high-risk group (12.8%) was the one of women with normal birthweight/large for gestational fetuses with an in vitro fertilization pregnancy. CONCLUSIONS: The highest incidence of poor neonatal outcome among women with reduced fetal movement was found in the groups with small for gestational age fetuses in nulliparous and multiparous women. A routine ultrasound assessment for fetal growth in third trimester is supposedly most efficient to identify undiagnosed small for gestational age. This article is protected by copyright. All rights reserved.