Maternal perception of decreased fetal movement & fetal outcome.

Thesis Report.

ABSTRACT: The purpose of this study was to dermine fetal outcome in term of neonatal status at birth, agar score at 1 and 5 minute, weight, congenital abnoramality, admission in neonatal care unit in women who perceived decreased fetal movement (FM) after 28 weeks of gestation who came to hospital. Hundred women who complaint of decreased FM were enrolled in the study from admission room. Equal number of comparative group matching gravida, period of gestation who were admitted after the study cases were also enrolled. This was a prospective study carried out in Maternity Hospital Thapathali. Total admission after 28 weeks of pregnancy during the study period was 3203, and complaint of decreased or loss of FM were 110 i.e. 3.4%. The hospital statistics shows 78% normal delivery and 22% is abnormal delivery. The caesarean section (c-section) rate is 10%. Stillbirth and neonatal death is 2.1% and 1.2% respectively. Low birth weight delivery rate is approximately 18% and preterm delivery rate is 4.5%. After admission fetal movement was confirmed objectively by perceiving FM on abdominal palpation for half an hour and fetal heart sound (FHS) were recorded, then they were observed for few days and followed up to till delivery. Cases with abnormal finding such as no fetal movement with slow or irregular FHS and / with FM with slow or irregular FHS were submitted to cardiotocography (CTG) or Ultrasonography (USG) evaluation. Adverse fetal outcome were taken as stillbirth, early neonatal death and neonatal care unit admission. Out of total 100 women in study group 43% of cases were in 39-40 weeks gestation. Cases below 37 weeks and above 40 weeks were 16% each, while 19% of cases occurred between 37-38 weeks gestation. There were 6% of women after 42 weeks of gestation. Adverse outcome in study group was 11 (10 SB, IENND) while it was 9(2SB, 7ENND) in comparative group. Nine cases in study group had fetal death on initial examiniation, one detected later on caesarean section, (anencephalyo). There were two fetal deaths in study group (p=0.037). There were 1 neonatal death in study group and 7 in comparative group (p=0.0648). Twelve percent (12%) required immediate delivery because of abnormal fetal evaluation like slow/irregular fetal heart sound. Caesarean section (CS) was carried out in 30 cases on study group for fetal distress, non-progress of labor, failed induction, elective, intrauterine growth retardation. While none had CS on comparative group (P= 0.00001). There was no significant difference in birth weight: apgar score and special care unit admission in both groups. As seen in this study caesarean section rate was 3 times more than average and still birth rate was 5 times more than the institutional statistics. It is seen that longer the duration of decreased FM more chances of adverse fetal outcome. Int this study it is found that fetal loss was 5.8 in cases with 48 horsof decreased fetal movement, 3.6% in > 2 to five days of duration and in > 5days duration it was 54.54% fetal loss. So women with decreased FM should report early to prevent these undesired events. KEY WORDS: decreased fetal movement; fetal outcome.

Eng.