Risk Factors and Outcomes of Reduced Fetal Movements among Women Admitted in Muhimbili National Hospital

Abstract

Background: Reduced fetal movements in pregnant women is a common cause of anxiety, non-schedule visits to antenatal clinics and admission. It is considered a high risk pregnancy with the fetus at risk of hypoxia and sudden death. Maternal vigilance of fetal activity and timely reporting to healthcare providers when experiencing a reduced fetal movements may prevent perinatal morbidity and mortality. Therefore fetal surveillance is always indicated to assess the fetal wellbeing and to aid in opportune time of delivery. At least 40 % of pregnant women are concerned about RFM one or more times in pregnancy. Four to 15% of women will contact their doctor because of persistent reduced fetal movements in their third trimester. The management of reduced fetal movements varied significantly in different hospitals. The purpose of this study is to establish risk factors and outcomes of RFM among women admitted and delivered at Muhimbili National Hospital. Objective: To determine risk factors for RFM and fetal outcomes of women admitted with RFM in Muhimbili National hospital. Study Design: Hospital based unmatched case control. Study took place in Muhimbili National Hospital during November 2016 to April 2017. Ninety cases and 181 controls Study site and setting: The study took place in the maternity wards at Muhimbili National Hospital. Methodology: Unmatched case control study was conducted between November 2016 and April 2017. Using a Systematic sampling technique, cases of single tone mothers who were admitted in the antenatal wards due to various conditions and reported RFM were consecutively recruited for the study shortly after delivery. For each case two controls were also selected based on closest timing of their deliveries to that of the case, preferably from the same ward as the case. Cases and controls were eligible if they were at the gestational age of 32 weeks or more at the time of delivery. Those who met eligibility criteria were asked for consent and after acceptance, a structured questionnaire was administered and the newborn outcomes were recorded from delivery notes. Data were analyzed by using IBM SPSS statistics version 20.0 software. Odds ratios and 95% CI were calculated to estimate risks for RFM and association of RFM with fetal outcome variables were established using Chi square. In all statistics, a p-value of <0.05 was considered significant. Ethical clearance was sought from MUHAS Senate Research and Publication Committee. Results: A total of 271 pregnant women who delivered at MNH were recruited in the study including 90 cases and 181 controls. Mean age of the case and control were 29.23±6.16 years and 28.43±6.28 years respectively. Factors that were independently associated with RFM were, pregnant women with no formal education were more likely to have reduced fetal movements as compared to those with secondary and above (AOR=2.26, 95% CI,:1.224 - 4.160, p 0.009). Women with history of alcohol intake were shown to be more likely to have reduced fetal movements as compared to those with no history of alcohol intake (OR=4.20,95% CI,:2.29 – 7.58, p <0.001) and obstetric factors that were independently associated with RFM were PIH ( OR= 2.44, 95% CI :1.41 – 4.17, p 0.001 ) and PPROM ( OR=3.83, 95% CI: 1.15 – 10.0, p 0.007 ). The risks for RFM presenting with any of the medical conditions were (AOR= 3, 95% CI: 1.95 – 14.10, p 0.001). CS delivery was slightly higher in RFM (81.1%) compared to women with normal fetal movements. (71.3%), p=0.082. ) and low birth weight (OR= 6.31, 95% CI:3.619-11.012, p <0.001), babies admitting to NBU (OR= 6, 95% CI: 3.542-10.424, p <0.001). Conclusion: RFM is independently associated with a number of social, obstetric and medical factors. Women who report persistent RFM were more likely to end up with poor fetal outcomes as compared to controls hence should never be ignored.