Fetal growth restriction (FRG) is a major challenge in obstetric care, and a significant risk for severe disabilities and death. Risk is reduced by early detection, but prediction in antenatal care is poor. FGR is associated with decreased fetal movements (DFM). Pregnant women universally perform self-screening based on perceived fetal movements (FM), but predictive values for FGR of a maternal sense of DFM are low. This screening nonetheless consumes significant health care resources, as 4-16% of pregnan t women present for evaluation due to DFM. There are no definitions of DFM to empower women in their self-screening. None are evidence based, and none have shown to predict FGR better than maternal common sense. A simple tool to increase the value of mate rnal self-screening could provide significant benefits for both patients and health care providers.
In prospective population-based cohorts of > 100,000 pregnancies with > 7,000 cases of DFM we have collected the largest materials to date in the Fetal Mov ement Intervention Assessment (FEMINA) collaboration. We have identified specific risk groups, are performing randomized controlled trials of routine FM counting in pregnancy, and have successfully implemented population-based stillbirth prevention progra ms. The next step of our collaboration is to provide a tool to increase the value of maternal self-screening. We have collected pilot maternal FM registrations by a new methodology in > 1,000 pregnancies, and can demonstrate FM pattern detection that impr oves predictive values for FGR significantly and early in pregnancy.
The aim of this proposal is to develop and validate Customized maternal FM charts in a prospective cohort, and demonstrate their predictive value for FGR in a double cross-validation pro cedure.
If as successful as indicated by pilots, this will provide sufficient evidence to initiate a randomized controlled trial - a trial that could have major implications for contemporary antenatal care.