Belfast Telegraph

Friday 19 September 2014

Foetus 'kick charts' unreliable

Pregnant women should not rely on counting the number of times their baby has kicked to ensure the foetus is well, research suggested today.

A study by a team at Cork University College Maternity Hospital said a combination of assessing the mother's risk factors and scanning the foetus should be used instead.

Using a kick chart, where a mother determines how well her baby is doing by counting the number of kicks, is unreliable, the study says, although it remains in use in a number of countries.

Rules as to how many kicks constitute a healthy baby are vague, the Irish research found, and the woman may not be able to count them accurately.

However, if the mother says her baby has reduced or no movement it can be an indicator of problems, the team said.

Dr Julia Unterscheider from the University of Cork said: "Around 15% of pregnancies are assessed in hospitals because the mother is concerned that her baby is not moving well.

"Obstetricians are often faced with the dilemma of not knowing what is best for mother and baby, as clinical guidance is inconsistent and management varies.

"Unnecessary investigation in an otherwise healthy pregnancy can lead to increased intervention such as caesarean delivery. In contrast, reduced foetal movements can represent a warning sign that the baby is small for gestation or unwell.

"We suggest that a careful history and examination together with a CTG (cardiotocograph) are used to confirm foetal wellbeing at a given time. Ultrasound evaluation is recommended when babies are at and beyond their due date, or when examination of the mother's abdomen suggests that the baby is small.

"Kick-charts, which are in use in many maternity units worldwide, are of no benefit to reducing poor outcomes in low-risk pregnant women. A mother's subjective perception of diminished movements is a better predictor of problems."

The research appeared in The Obstetrician and Gynaecologist today.

Editor-in-chief Jason Waugh said: "Understandably, mothers get very anxious when they haven't felt the baby kicking for a while and think there may be something amiss.

"There are several plausible reasons why this may be, including the foetus being in a state of sleep, the mother being on a course of sedatives, or even the mother being too busy to focus on foetal activity.

"Because these sensations are so subjective, and the circumstances are different from mother-to-mother, the authors of this paper are advising healthcare professionals not to rely on foetal kick-charts alone."

National clinical guidelines say that movement counting should not be used in ante-natal care.

General secretary of the Royal College of Midwives Cathy Warwick said: "Every expectant mother with concerns about not feeling their unborn babies' movements should be taken seriously and should contact their midwife and maternity services as soon as possible.

"The use of these kick charts has now been superseded by the use of more advanced and reliable medical technology, such as ultrasound scans.

"This is why it is so important that midwives receive funding for continuous professional development training to unsure that they are able to keep up with current practice. Anecdotally, we have heard that our members are struggling to receive and access essential training to keep them up-to-date in their practice."

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