Diagnosis of fetal jeopardy by assessment of fetal movement and heart rate accelerations.

Assessment of fetal movements by the pregnant woman is a useful screening test in high and low risk pregnancies. Decreased fetal movements to less than 10 during 12 hours is an expression of fetal distress, and may be the first alert of impending fetal death. Pregnancies with decreased fetal activity comprise a very high risk group, however some normal pregnancies are still included. With the object of excluding false positive observations, fetal heart rate monitoring was added as a secondary screening procedure. There were seventy patients with diminished fetal movements, 28 had two or more fetal heart rate accelerations in twenty minutes, while 42 had one or no accelerations in twenty minutes. In the former group there was no perinatal mortality, while in the latter, 18 (42.8%) succumbed either pre- (16.6%) or post-natally (26.2%). It is suggested that daily fetal movement recording should be the primary screening test for pregnant women. Whenever reduced fetal activity to less than 10 in 12 hours is perceived, fetal heart rate should be monitored. The existence of at least two accelerations in 20 minutes excludes all the fetuses prone to disaster. One or no accelerations in 20 minutes when coexisting with decreased fetal movements, have a very grave prognosis, and interruption of pregnancy should be considered.