Improving Research and Practice Related to Encouraging Awareness of Reduced Fetal Movement and its Subsequent Clinical Management

Student thesis: Phd


Introduction Maternal concern about reduced fetal movements (RFM) is a common reason for presentation to maternity care and studies have shown associations between RFM and adverse pregnancy outcomes such as stillbirth and fetal growth restriction (FGR). Despite this, studies of interventions for encouraging awareness of RFM and/or its subsequent clinical management have shown varying results, and systematic reviews of these studies have been inconclusive. Guidelines for RFM vary in quality and are not informed by all the available evidence. This thesis aimed to improve future research and clinical practice related to RFM. Methods To achieve the objectives of this thesis, three studies were conducted: 1. A systematic review of interventions for encouraging awareness of RFM and/or improving its subsequent clinical management, considering both randomised and non-randomised studies; 2: Development of a core outcome set (COS) for future studies of RFM, and; 3. A survey of UK-based clinicians’ knowledge and practice related to RFM. Results Current evidence is insufficient for drawing many definitive conclusions about the effect of interventions for RFM on adverse outcomes. Interventions aimed at encouraging awareness of RFM may reduce neonatal intensive care unit (NICU) admissions and fetal movement counting may lead to decreased maternal anxiety and increased maternal-fetal attachment. COS for studies aimed at encouraging awareness and/or improving its subsequent clinical management were created. A survey of clinicians’ knowledge and practice related to RFM showed that although knowledge and practice has improved, there is still a lot of variation in the guidelines that are followed, leading to variation in care. Discussion The next step in RFM research should be to conduct international adequately powered trials of (multifaceted) interventions, measuring all outcomes specified by the COS. Variation in clinical practice still exists and may be influenced by the strength of recommendations behind guidelines; better trials will increase the likelihood that future evidence syntheses will be able to make recommendations.
Date of Award1 Aug 2023
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorTanya Walsh (Supervisor), Alexander Heazell (Supervisor) & Jo Dumville (Supervisor)


  • meta-analysis
  • core outcome set
  • reduced fetal movement
  • systematic review

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