Doppler velocimetry and nonstress test for predicting outcome of pregnancies with decreased fetal movements.

Because fetal motor activity reflects the fetal condition in utero, maternal counting of fetal movements has been suggested as a useful method for monitoring fetal well-being, based on empirical evidence that a decrease in or absence of fetal movements often presages fetal death. The aim of this study was to compare the predictive capacity of umbilical artery (UA) Doppler velocimetry with that of nonstress test (NST) cardiotocography in 599 women with low-risk pregnancies, reporting decreased fetal movements. In 19 cases the fetus was dead on maternal admission. Umbilical artery Doppler velocimetry and NST were performed in the remaining 580. In 541 the NST and UA velocimetry findings were reassuring, and the women were discharged. There was one perinatal death in this group, due to extreme prematurity and placental abruption 1 week later. Thirty-nine women who gave birth on the day of admission or next day were especially given closer attention. Umbilical artery velocimetry was abnormal in only one fetus. In 6 cases, the NST trace on admission indicated fetal distress, and emergency cesarean section was performed, resulting in 3 infant deaths and 3 infants with sequelae. The umbilical cord pH was normal in 3, suggesting an earlier temporary intrauterine hypoxic event. Overall perinatal mortality was thus 23 (3.8%). Decreased fetal movement perception by mothers should therefore be taken seriously, even though an irreversible insult to the fetus might already have occurred.