Surveillance of decreased fetal movements: a critical appraisal of Australian antenatal guidelines

Background: Maternal concerns regarding decreased fetal movement is one of the most common reasons for hospital presentation in the antenatal period. Decreased fetal movement is associated with adverse perinatal outcomes such as stillbirth as well as higher rates of induced labour and caesarean section. Compared to other OECD nations over the last decade, Australia's rate of obstetric intervention is increasing without a commensurate reduction in stillbirth rates. Aim: To assess the quality of antenatal decreased fetal movement guidelines published in Australia. Methods: This study evaluated eleven Australian antenatal guidelines concerned with surveillance of decreased fetal movement after 28 weeks’ gestation in singleton pregnancies, using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. Findings: Guidelines demonstrated wide variation in overall quality. Areas of strength were scope and presentation, and areas of weakness were implementation and rigour of development of recommendations. Two guidelines, the PSANZ-SANDA and AUS guideline, received high-quality appraisals and were often referenced in other guidelines. All guidelines highlighted critical gaps in evidence pertaining to defining decreased fetal movement, consent and its withdrawal, initiation and cessation of surveillance, and progression to intervention. Conclusion: This study highlighted varying quality of current guidelines, revealing a lack of consistency and robust research in this area on which to base practice. It emphasised the need for a nationally recognised evidence-based guideline or significant improvement of current guidelines. The findings add to a growing body of knowledge about relationships between repeated monitoring, intrapartum decision-making, and perinatal outcomes.