Fetal movement count may prevent fetal death as early as 26 weeks

Although it is not established whether fetal movement counting (FMC) reduces fetal death 1, a Norwegian study 2 found that after introduction of FMC the stillbirth rate fell by 30% in their study population of 46 000 singleton pregnancies and fell by 50% among the 3500 women from that group who reported decreased fetal movement. Then, how early can FMC detect a fetus in jeopardy and possibly save lives? We established a reference value of fetal movement from 22 weeks until term 3. We use FMC for all pregnant women visiting us, with the 260/7 week being the first fill-in week. A primiparous woman with an uneventful pregnancy course felt decreased fetal movements on the second day of starting the fill-in, at 261/7 weeks. She visited us the next day, with the chief complaint of decreased fetal movements. Cardiotocography indicated minimal variability without bradycardia or deceleration. We then performed ultrasound, with her lying in a left semi-lateral position, which revealed an appropriate-for-date infant with normal amniotic fluid volume; however, a hypercoiling of the cord was also discovered, with the measured umbilical coiling index being 1.17 coils/cm. The umbilical coiling index was defined as the number of umbilical vascular coils (turns) divided by the cord length (cm) of the corresponding cord part, with >0.3 coil (turn)/cm considered as hypercoiling 4. During ultrasound, we noticed occasional fetal bradycardia: repeated cardiotocography revealed recurrent severe variable decelerations. The presence of cord hypercoiling together with this fetal heart rate pattern strongly suggested a non-reassuring fetal status. We performed cesarean section to deliver an 800 g male infant with Apgar scores 3/7 (1/5 min). The infant was hospitalized in the intensive care unit, and did well without sequelae. Cord hypercoiling was confirmed and the fetal end of the cord had become very thin. It is impossible to conclude that this infant would have died if the mother had not recorded her FMC, and so had not visited us. However, hypercoiling and recurrent severe variable decelerations strongly suggested fetal death if the baby had remained undelivered. To our knowledge, this is the earliest week of gestation reported in which FMC possibly led to saving a fetus or an infant. Earlier we reported on decreased fetal movement in a stillbirth case that showed the need for extra vigilance for babies at term 5, and the Norwegian study 1 and FMC brochures attached to it encourage vigilance in late-term pregnancy recommending that counting start at approximately 28 weeks of gestation. This case suggests that it may be beneficial to start FMC even earlier.