Ultrasound technique enhances decision making for reduced fetal movement

It can be difficult to decide whether to expedite birth when a woman in the final stage of pregnancy perceives less fetal movements. An additional ultrasound measurement to assess resistance infetal blood vessels can help make this decision more accurately, leading to fewer complications during delivery.

This is the conclusion of a large international study led by gynecologist Sanne Gordijn from the University Medical Center Groningen (UMCG), in collaboration with Wessel Ganzevoort from Amsterdam UMC.

Reduced fetal movement can be concerning

Sometimes, pregnant women perceive less fetal movements in the final weeks of pregnancy. Usually, this is not a cause for concern-the baby may be in a different position, or the mother may have been busy and not noticed the movements. However, it can be alarming for both the pregnant woman and healthcare providers, as it may precede severe oxygen deprivation or even fetal death. In such cases, the placenta may not be functioning properly, resulting in reduced oxygen and nutrient supply to the baby. Early delivery, before severe hypoxia occurs, may then be the best option.

Hospital visit for reduced fetal movement

Currently, when a pregnant woman reports reduced fetal movement in the final weeks, she is referred to a hospital. There, routine assessments are performed as soon as possible to evaluate the fetal condition. These include a fetal heart rate tracing and an assessment of fetal growth and amniotic fluid levels. While these details provide insight into the fetal condition, there may be more effective ways to assess it.

Is the placenta functioning normally?

The researchers studied the effect of additional ultrasound measurements to assess placental function. The study focused on the resistance in the blood vessels of the umbilical cord and the fetal brain. These measurements provide further insight into placental function and the baby's condition. A total of 1,684 women participated in the study.

To expedite birth or not?

The study primarily examined the resistance in the blood vessels of the baby's brain and umbilical cord. Sanne Gordijn explains: "The ratio between these two measurements is called the Cerebroplacental Ratio (CPR). The idea is that an abnormal CPR value, which may indicate a poorly functioning placenta, suggests it is better to expedite birth. If the CPR is normal, it may be better to wait, as the baby may not yet be ready. Women who wish to give birth at home can still do so in that case."

Fewer complications after additional blood vessel measurement

The results of the CEPRA study show better outcomes for fetuses when the CPR measurement is known. Gordijn: "This means we see fewer complications around birth when this measurement is performed in cases of reduced fetal movement, compared to current practice where it is not."

Clinical guidelines

According to Gordijn, the study provides essential information for obstetric care: "If doctors know the CPR result, they can better determine whether reduced fetal movement is harmless or requires action. This ensures that both mother and baby receive the care best suited to their situation." The guideline on reduced fetal movement will soon be updated, and the professional association will incorporate the study's findings.