Study: Foetal kick charts ‘of little value’
Instead, nurses and doctors should rely on the mother’s own instinct on whether she believes foetal movement has decreased.
In addition, Dr Julia Unterscheider, who carried out the study, said there was little value in counting kicks over a set period of time when there was “a lack of clear agreement” among midwives and obstetricians over the number of kicks that may indicate abnormal movement.
“We don’t really agree on what constitutes reduced foetal movement.
“This causes more confusion. Women may be told less than 10 kicks in two hours is abnormal, or less than 10 kicks in 12 hours when the reality is it is quite subjective. Every mother’s baby moves differently, this is proven in scans and every mother experiences movement differently, therefore sitting there, counting kicks is not a good idea. It is not a good method of assessing foetal movement,” Dr Unterscheider said.
Dr Unterscheider, a specialist registrar who is now based at the Rotunda Hospital but who previously worked at Cork University Maternity Hospital where she carried out her research at the Anu Research Centre, recommends discontinuing the use of foetal kick charts.
In a paper published today in the online journal The Obstetrician & Gynaecologist (TOG), Dr Unterscheider says using foetal kick charts can result in women over or under counting the number of movements in the womb and she recommends that obstetricians identify women who are at-risk through a standard assessment, including considering the mother’s previous medical history alongside information such as levels of alcohol consumption and smoking.
Further investigations should include using ultrasound scanning and cardiotocography (counting foetal heart beats) to measure the foetus’ progress, Dr Unterscheider says.
“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.”
Dr Unterscheider said the current situation where pregnant women in the public system do not receive their first scan until 20 weeks “was certainly a problem”.
“A late scan does not confirm the due date. A scan within the first 12 weeks is best for this purpose. It would be great to see women earlier, you can pick up any risk factors earlier. Saying that, we can still assess quite a lot at 20 weeks,” Dr Unterscheider said.
