Research Sources:

Alterations in frequency of fetal movements are important in identifying pregnancies at increased risk of stillbirth, with the greatest risk in women noting a reduction in fetal activity. (Alterations in maternally perceived fetal movement and their association with late stillbirth: findings from the Midland and North of England stillbirth case–control study,Alexander E P Heazell,1,2 Jayne Budd,2 Minglan Li,3 Robin Cronin,3 Billie Bradford,3Lesley M E McCowan, Edwin A Mitchell,4 Tomasina Stacey,5 Bill Martin,6Devender Roberts,7,8 John M D Thompson)

Maternal   perception   of   fetal   activity   is   an   accepted   marker   of   fetal   well-being.   Conversely,  maternal  perception  of  changes  in activity can indicate fetal compromise; the most  commonly  reported  change  is  a  reduction  in  fetal  movement (Sadovsky E, Ohel G, Havazeleth H, et al. The definition and the significance of decreased fetal movements. Acta Obstet Gynecol Scand 1983;62:409–13.2.Leader LR, Baillie P, Van Schalkwyk DJ. Fetal movements and fetal outcome: a prospective study. Obstet Gynecol 1981;57:431–6.) 

Maternal  perception  of  reduced  fetal  movements  (RFM)  is  associated  with  adverse  pregnancy  outcomes  including  fetal  growth  restriction (Heazell AE, Frøen JF. Methods of fetal movement counting and the detection of fetal compromise. J Obstet Gynaecol 2008;28:147–54.) 

Despite the known association between RFM and stillbirth, two Confidential Enquiries into antepartum  stillbirth  in  the  UK  conducted  15    years    apart    highlighted    suboptimal    care  in  terms  of  the  information  given  to  mothers  about  fetal  movements  and  clinical information  given  to  mothers  about  fetal  movements  and  clinical management  when  mothers  attend  with  RFM  as  factors  contributing to stillbirth (Maternal and Child Health Research Consortium. Confidential enquiry into stillbirths and deaths in infancy: 8th Annual Report, 1 January–31 December 1999. London: Maternal and Child Health Research Consortium, 2001.) 

Data  from  two  case–control  studies  and  a  large  international  cohort  study  have  both  suggested  that  any  significant  deviation  from a mother’s usual pattern of fetal movement is a risk factor  for  stillbirth (Stacey T, Thompson JM, Mitchell EA, et al. Maternal perception of fetal activity and late stillbirth risk: findings from the Auckland Stillbirth Study. Birth 2011;38:311–6.) 

Women report receiving  mixed  messages  about  the  importance  of  fetal  movements  and  the  significance  of  RFM,  indicating  the  need  for  clear  information  regarding  these  symptoms (Smyth RM, Taylor W, Heazell AE, et al. Women's and clinicians perspectives of presentation with reduced fetal movements: a qualitative study. BMC Pregnancy Childbirth 2016;16:280.

Women whose pregnancy ended in stillbirth were less likely to check fetal movements (aOR 0.54, 95% CI 0.35–0.83) and were less likely to be told to do so by a health professional (aOR 0.55, 95% CI 0.36–0.86). Pregnancies ending in stillbirth were more frequently associated with significant abnormalities in fetal movements in the preceding two weeks; this included a significant reduction in fetal activity (aOR 14.1, 95% CI 7.27–27.45) or sudden single episode of excessiv efetal activity (aOR 4.30, 95% CI 2.25–8.24). Cases described their perception of changes in fetal activity differently tohealthy controls e.g. vigorous activity was described as“frantic”,“wild” or “crazy” compared to “powerful” or “strong”. Conclusions: Alterations in fetal activity are associated with increased risk of stillbirth. Pregnant women should be educated about awareness of fetal activity and reporting abnormal activity to health professionals.  -(Stillbirth is associated with perceived alterations in fetal activity–findings from an international case control study Alexander E. P. Heazell1,2*, Jane Warland3, Tomasina Stacey4, Christin Coomarasamy5, Jayne Budd1,Edwin A. Mitchell 5 and Louise M. O’Brien6)