Pregnancy outcomes in women presenting with single versus multiple episodes of reduced fetal movements: A prospective observational study
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Data source and population This was a prospective observational study conducted in the Department of Obstetrics and Gynecology of our Institute from Jan 2016 to May 2019. The Institutional Ethical Committee approved this study. The study population included antenatal women who presented primarily with reduced fetal movements to our department. Further, the study included singleton pregnancies, with cephalic presentation and gestational age > 34 weeks. The exclusion criteria were multiple pregnancies, previous lower segment caesarean section (LSCS), placenta previa, abruptio placentae and major congenital malformations in the fetus. A system of convenience sampling was used for including patients for this study. Methodology Informed consent was obtained from the participating women, followed by detailed history-taking with respect to maternal demographics (age, height, weight, BMI), pregnancy related characteristics (parity, gestational age), antenatal risk factors, as well as past obstetric, medical and surgical history. Clinical examination was performed in a systematic manner. All women were subjected to ultrasonography (USG) examination and non-stress test (NST). The NST was performed with cardiotocogram (Bistos BT-350) in Semi-Fowler’s position. NST was classified as reactive if 2 or more accelerations of more than 15 beats per minute above the baseline and lasting longer than 15 seconds in 20 minutes window period with no decelerations were recorded. If these features were absent, NST was classified as non-reactive. Real-time USG scanning was performed using a 3.5 MHz sector probe (GE Medical system Logic Q P5). After a general survey of the fetus, presentation and placental location were noted. Parameters measured were estimated fetal weight (EFW) and amniotic fluid index (AFI). USG was termed as normal when all the parameters (including AFI & EFW) were within normal limits. Oligohydramnios was defined as AFI less than 5 cm and polyhydramnios as AFI more than 25 cm. EFW less than 10th percentile of specific gestational age was used to diagnose intrauterine growth retardation (IUGR). Women who had presented with the first episode of decreased fetal movement, and who had reactive NST with normal USG findings, were allowed to go home and advised for weekly follow up. Pregnant women who presented with a single episode of decreased fetal movements at term, and had oligohydramnios or IUGR or persistent non-reactive NST were offered induction. Pregnant women with gestational age between 34-37 weeks of gestation, who presented with a single episode of reduced fetal movements, underwent biophysical profile scoring if NST or USG was abnormal. Doppler velocimetry was done if IUGR was present. A course of steroids was given to women with any features suggestive of fetal compromise, and delivery was expedited. Those with normal biophysical profile, were followed up with intensive antenatal surveillance.