Antepartum fetal surveillance in the patient with decreased fetal movement.

Whenever a patient has the subjective perception of decreased fetal movement, prompt evaluation in the form of antepartum fetal surveillance has been undertaken. The purpose of this report is to describe our experience with 489 pregnant women who came between Jan. 1 and Dec. 31, 1985 to our Antepartum Fetal Surveillance Clinic with this complaint alone or in association with another indication for fetal surveillance. Overall, 838 nonstress tests were performed, and the results were reactive, 93.2%; nonreactive, 6.8%; and fetal heart rate decelerations, 6.1%. Comparison of the first nonstress test results between those with decreased fetal movement alone or in combination with another diagnosis demonstrated a similar incidence of nonreactivity and fetal heart rate decelerations. In those patients whose indication was decreased fetal movement alone, there was a 3.7 times greater likelihood of diminished amniotic fluid volume. When the last test within 7 days of delivery was analyzed, the decreased fetal movement alone group had a lower incidence of cesarean delivery, cesarean delivery for fetal distress, and Apgar scores less than 7 than patients with an additional indication for testing. In summary, decreased fetal movement continues to be an acceptable indication for fetal surveillance. Based on our retrospective experience, the most reasonable approach appears to be a combination of nonstress test and amniotic fluid volume assessment. Unless the patient has additional indications for fetal surveillance, the patient with decreased fetal movement with a reactive nonstress test and a normal amniotic fluid volume does not appear to warrant additional testing.