Cardiotocography as a predictor of fetal outcome in women presenting with reduced fetal movement

Objective: To examine the obstetric and perinatal outcomes of women presenting with reduced fetal movement (RPM) during the third trimester, specifically in relation to the diagnostic capacity of non-stress cardiotocography (CTG) used as the primary investigation in this clinical scenario. Study design: This was a retrospective population-based cohort study of pregnancy outcomes of all women >= 28 weeks' gestation with singleton pregnancies presenting during one calendar year with maternal perception of RPM, all of whom underwent CTG at presentation. Main outcome measures included: obstetric intervention (induction of labour, spontaneous vaginal delivery, operative vaginal delivery, emergency caesarean section), and perinatal outcome (subsequent perinatal death, low Apgar scores (<7(5)), neonatal resuscitation and NICU admission). Results: In all, 524 women presented with RFM and a live fetus, representing 7% of the antenatal obstetric population; 284 women (54%) were nulliparous. The reassuring CTG group comprised 482 (92%) women in whom initial CTG was reassuring and 15 (3%) where a repeat tracing within 1 h was reassuring. The non-reassuring/abnormal CTG group (n = 27, 5%) either underwent emergency delivery or comprehensive serial fetal assessment; this group had significantly higher rates of emergency caesarean delivery, neonatal resuscitation and NICU admission; the incidence of small-for-gestational-age infants did not differ significantly. No perinatal death occurred in either group following CTG. Conclusion: Normal non-stress CTG is a reliable screening indicator of fetal wellbeing in women presenting with perception of RPM in the third trimester; abnormal pregnancy outcomes were more common when initial CTG was abnormal or persistently non-reassuring. (C) 2011 Published by Elsevier Ireland Ltd.