Decreased fetal movement: Maternal characteristics and pregnancy outcome


Khaoula Magdoud
Abir Karoui
Hassine Saber Abouda
Sana Menjli
Haithem Aloui
Mohamed Badis Chanoufi


Introduction : Decreased fetal movement is a common reason for consultation. It can reveal an intrauterine death or fetal distress.

Aim: To evaluate the epidemiological profile of decreased fetal movement and to identify the predictive factors of poor pregnancy outcome. 

Methods: We performed a retrospective and descriptive study in the department of Maternity between January 2015 and December 2019 including patients hospitalized for decreased fetal movements.                         

Results: The study included 150 patients with a mean age of 30.7±5.8 years. The patients were primiparous in 45.3% of cases. The mean term of pregnancy was 37.17±2.97 weeks. Cardiotocography was pathological in 22.7% of patients. The delivery rate during the hospitalization was 87.3% with a mean term of 37.9±2.5 SA. Poor pregnancy outcome was noted in 22.1% of cases. The identified predictive factors of poor pregnancy outcome were: gestational term less than 37 weeks (ORa=9.42), insufficient prenatal care (ORa=2.85), delayed maternal reporting of decreased fetal movement (ORa=1.29), complications during pregnancy (ORa=3.01),small symphysiofundal height for gestational age (ORa=6.17), pathological cardiotocography (ORa=1.66), fetal growth restriction (ORa=6.17), abnormal Umbilical Artery Doppler (ORa=6.51).

Conclusion: Decreased fetal movement can be a false alarm but it is important to identify predictive factors of poor pregnancy outcome to recognize patients at increased risk and optimize their management.


Fetal movement, Fetal distress, Stillbirth, Pregnancy outcome, Predictive factors



  1. Gillieson M, Dunlap H, Nair R, Pilon M. Placental site, parity, and date of quickening. Obstet Gynecol. 1984;64(1):44‑5.
  2. Berbey R, Manduley A, VigilDe Gracia P. Counting fetal movements as a universal test for fetal wellbeing. Int J Gynecol Obstet. 2001;74(3):293‑5.
  3. Unterscheider J, Horgan RP, Greene RA, Higgins JR. The management of reduced fetal movements in an uncomplicated pregnancy at term: results from an anonymous national online survey in the republic of Ireland. J Obstet Gynaecol. 2010;30(6):578‑82.
  4. Sergent F, Lefèvre A, Verspyck E, Marpeau L. Diminution des mouvements actifs du fœtus au troisième trimestre : que faire ?.Gynecol Obstet Fertil. 2005;33(11):861-9.
  5. Bellussi F, Po G, Livi A, Saccone G, De Vivo V, Oliver EA, et al. Fetal movement counting and perinatal mortality: a systematic review and meta-analysis. Obstet Gynecol. 2020;135(2):453‑62.
  6. Tveit JH, Saastad E, Stray Pedersen B, Bordahl PE, Flenady V, Fretts R, et al. Reduction of late stillbirth with the introduction of fetal movement information and guidelines – a clinical quality improvement. BMC Pregnancy Childbirth. 2009;9(1):32.
  7. Holm Tveit JV, Saastad E, Stray Pedersen B, Bordahl PE, Froen JF. Maternal characteristics and pregnancy outcomes in women presenting with decreased fetal movements in late pregnancy. Acta Obstet Gynecol Scand. 2009;88(12):1345‑51.
  8. Heazell AP, Sumathi GM, Bhatti NR. What investigation is appropriate following maternal perception of reduced fetal movements?. J Obstet Gynaecol. 2005;25(7):648‑50.
  9. Sheikh M, Hantoushzadeh S, Shariat M. Maternal perception of decreased fetal movements from maternal and fetal perspectives, a cohort study. BMC Pregnancy Childbirth. 2014;14(1):286.
  10. Bhatia M, Mitsi V, Court L, Thampi P, El Nasharty M, Hesham S, et al. The outcomes of pregnancies with reduced fetal movements: a retrospective cohort study. Acta Obstet Gynecol Scand. 2019;98(11):1450‑4.
  11. Heazell AP, Froen JF. Methods of fetal movement counting and the detection of fetal compromise. J Obstet Gynaecol. 2008;28(2):147‑54.
  12. O’sullivan O, Stephen G, Martindale E, Heazell AP. Predicting poor perinatal outcome in women who present with decreased fetal movements. J Obstet Gynaecol. 2009;29(8):705‑10.
  13. Warland J, O’Brien LM, Heazell AP, Mitchell EA. An international internet survey of the experiences of 1,714 mothers with a late stillbirth: the STARS cohort study. BMC Pregnancy Childbirth. 2015;15:172.
  14. Norman JE, Heazell AP, Rodriguez A, Weir CJ, Stock SE, Calderwood CJ, et al. Awareness of fetal movements and care package to reduce fetal mortality (AFFIRM): a stepped wedge, cluster-randomised trial. Lancet. 2018;392(10158):1629‑38.
  15. Efkarpidis S, Alexopoulos E, Kean L, Liu D, Fay T. Case-control study of factors associated with intrauterine fetal deaths. MedGenMed. 2004;6(2):53.
  16. Sterpu I, Pilo C, Koistinen IS, Lindqvist PG, Gemzell Danielsson K, Itzel EW. Risk factors for poor neonatal outcome in pregnancies with decreased fetal movements. Acta Obstet Gynecol Scand. 2020;99(8):1014‑21.
  17. Dutton PJ, Warrander LK, Roberts SA, Bernatavicius G, Byrd LM, Gaze D, et al. Predictors of poor perinatal outcome following maternal perception of reduced fetal movements – a prospective cohort study. PLoS One. 2012;7(7):e39784.
  18. Sadovsky E, Ohel G, Havazeleth H, Steinwell A, Penchas S. The definition and the significance of decreased fetal movements. Acta Obstet Gynecol Scand. 1983;62(5):409‑13.
  19. Turner JM, Flenady V, Ellwood D, Coory M, Kumar S. Evaluation of pregnancy outcomes among women with decreased fetal movements. JAMA Netw Open. 2021;4(4):e215071.
  20. Heazell AP, Warland J, Stacey T, Coomarasamy C, Budd J, Mitchell EA, et al. Stillbirth is associated with perceived alterations in fetal activity – findings from an international case control study. BMC Pregnancy Childbirth. 2017;17(1):369.
  21. Stacey T, Thompson JD, Mitchell EA, Ekeroma A, Zuccollo J, McCowan LE. Maternal perception of fetal activity and late stillbirth risk: findings from the auckland stillbirth study. Birth. 2011;38(4):311‑6.
  22. McCarthy CM, Meaney S, O’Donoghue K. Perinatal outcomes of reduced fetal movements: a cohort study. BMC Pregnancy Childbirth. 2016;16(1):169.
  23. Akselsson A, Lindgren H, Georgsson S, Pettersson K, Radestad I. Increased labor induction and women presenting with decreased or altered fetal movements - a population-based survey. PLoS One. 2019;14(5):e0216216.
  24. Saastad E, Ahlborg T, Froen JF. Low maternal awareness of fetal movement is associated with small for gestational age infants. J Midwifery Womens Health. 2008;53(4):345-52.
  25. Wondemagegn AT, Alebel A, Tesema C, Abie W. The effect of antenatal care follow-up on neonatal health outcomes: a systematic review and meta-analysis. Public Health Rev. 2018;39:33.
  26. roen JF, Saastad E, Tveit JH, Bordahl PE, Stray Pedersen B. Clinical practice variation in reduced fetal movements. Tidsskr Nor Laegeforen. 2005;125(19):2631-4.
  27. Froen JF, Arnestad M, Frey K, Vege A, Saugstad OD, Stray Pedersen B. Risk factors for sudden intrauterine unexplained death: epidemiologic characteristics of singleton cases in Oslo, Norway, 1986-1995. Am J Obstet Gynecol. 2001;184(4):694‑702.
  28. Daly N, Brennan D, Foley M, O’Herlihy C. Cardiotocography as a predictor of fetal outcome in women presenting with reduced fetal movement. Eur J Obstet Gynecol Reprod Biol. 2011;159(1):57‑61.
  29. Samira Hassoune, Said Bassel, Samira Nani, Abderrahmane Maaroufi. Prévalence et facteurs associés au faible poids de naissance à la maternité de l’hôpital provincial de mohammedia – maroc. La tunisie Medicale - 2015 ; Vol 93 ( n°07 ) : 440-444