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PP22 Reduced fetal movement: an evaluation of emergency department attendance
  1. CM McCarthy1,
  2. S Meaney2,
  3. K O’Donoghue1
  1. 1Department of Obstetrics and Gynaecology, University College Cork and Cork University Maternity Hospital, Cork, Ireland
  2. 2National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland

Abstract

Background Reduced Fetal Movement (RFM) is a common antenatal complaint, conferring increased perinatal morbidity and mortality. There are currently no national standards of care advising the appropriate assessment and management of those with RFM, with guidance offered by the Royal College of Obstetricians and Gynaecologists detailing how these women should be investigated.1 The patient experience with the health service is an important factor in satisfaction, and influences public perception of the health service. Longer waiting times, and outcomes of the consultation are important elements of the patient experience.

We aimed to examine patient interaction and attendance to the Emergency Department (ED) when presenting with RFM.

Methods We prospectively recruited women presenting with RFM with a singleton pregnancy over 28 weeks gestation, without a known congenital anomaly to a tertiary-level Irish maternity hospital (8300 deliveries per year) between April 2013 and October 2013. Details of their presentation, including waiting times and how women were assessed and admission rate following assessment were collected. Secondly, telephone records were analysed for two non-consecutive months (April and August 2013) during the study period to assess advice offered to those with RFM.

Results There were 1912 telephone consultations to the ED over two months, with 74 (3.9%) women complaining of RFM, but we were unable to correlate these women to actual presentations. In total, 295 women presented with RFM over a seven month period, accounting for 4.2% (n = 6989) of all attendances to the ED in this seven month period. 56% (n = 165) of women attended the ED during peak staffing times (0800 h–1700 h). 51.1% (151/295) women were assessed and managed within three hours of presentation. Following presentation with RFM, 26.5% (n = 73) of women were admitted to hospital for further monitoring and management with 79.4% (n = 58) of these delivered following admission. Of the total cohort, 15.2% (n = 42) had an induction of labour for RFM.

Discussion There is no clear guidance on the assessment or management of RFM, a common antenatal presenting complaint associated with poor perinatal outcomes. Women with RFM have a high admission and subsequent intervention rates. Our study highlights the importance of clear guidance and the need for continued research in the management of RFM, in order to optimise patient outcomes, and also decreased perinatal morbidity and mortality.

  • Perinatal mortality
  • pregnancy outcome
  • perinatal epidemiology

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