The Role of Maternal Fetal Movement Assessment on Antepartum Fetal Testing and Perinatal Outcomes Among Selected High-risk Pregnancies at the Kenyatta National Hospital, 2014-2018 (a Five-year Retrospective Cohort Study)

Abstract

A high-risk pregnancy is that in which the life of the gravid woman or her fetus is threatened. Factorsassociated with high-risk pregnancy include; pre-existing medical conditions, pregnancy-related complications and inherent fetal health problems. Some of the commonest high-risk conditions include hypertensive disorders of pregnancy (HDPs), diabetes mellitus (DM) and post-term pregnancies whichaffect approximately8-10%, 16.2% and 5-10%of pregnancies in that order.Fetal surveillance tests such as maternal fetal movement assessment, fetal heart sound auscultation, cardiotocography (CTG) and ultrasound biophysical profile (BPP)and doppler velocimetry identify at-risk fetuses and therefore predict or prevent adverse perinatal outcomes. Maternal fetal movement assessment (FMA)is a valuable test because it’s easy to perform andinexpensive. Although FMA may not predictperinatal outcomes for all pregnancies, irrespective of the riskstatus, its role in high-risk pregnancies especially in low resource setting has not been fully described. In this study, we evaluated the antepartum fetal testing profile, early perinatal outcomes and the role of maternalfetal movement assessment in predicting adverse pregnancy outcomes specifically amongHDP,DM and post term pregnancies. Objectives: To describe the antepartum fetal testing profile and perinatal outcomes and evaluate the role of maternal fetal movement assessment among selected high-risk pregnancies at Kenyatta National Hospital. Methodology Study Design: Records based retrospective cohort study Sampling: Simple random sampling Data collection: Standardpre-coded and pretested data abstraction tools were employed to collect relevant data. Statistical analysis: Continuous data variables were analysed as mean and standard deviation from the mean and t-test used to evaluate for association. For categorical variables, frequencies were obtained and compared using chi-square test. Relative risks werecalculated. A p-value of less than 0.05 was considered statistically significant. Results: Between January 2014and December 2018 we examined records of 1372 women and 392(28.6%) werefound to be eligible. Thesecomprised 196(14.3%) records of women who reported normal fetal movements and 196 records of womenwho perceived reduced fetal movements. The mean age of the patients was 29.6 (standard deviation=6.2) years. A total of 140(35.7%) had hypertension, 67(17.1%) had diabetes mellitus, 132((33.7%) had post-term pregnancies and 53 women (13.5%) had more than one of these three conditions. The most prevalent antepartum fetal test wasBPP (51.5%), followed by CTG (46.7%),umbilical artery resistive index (44.9%) and middle cerebral artery (MCA) resistive index (16.1%) in that order. The prevalence of fetal testing was significantly higher in the reduced fetal movement (RFM) group%) compared to normal fetal movement (NFM) group (CTG 60.2% vs 33.2%, BPP 67.3% vs 35.7%, umbilical artery RI 58.7%vs 31.1%, MCA RI 22.4 vs 9.7%), p < 0.05. There were 55(14%) adverse perinataloutcomes, specifically,stillbirths,poor APGAR scores and early neonatal death. Theprevalence of these outcomes was higher in those who .....