Evaluation of the quality of guidelines for the management of reduced fetal movements in UK maternity units

Table 1 Percentage of unit guidelines stating recommendations in RCOG national guideline

Recommendation	Percentage of guidelines
Take a clinical history (including risk factors for stillbirth) [B]	79
Clinical examination (including symphysis-fundal height) [B]	81
Auscultation of the fetal heart (with Pinnard stethoscope or handheld Doppler device) [B]	69
Screening for preeclampsia by urinalysis and blood pressure [GPP]	43
After fetal viability has been confirmed and history confirms a RFM, arrangements should be made for the woman to have a cardiotocograph (CTG) to exclude fetal compromise [B]	100
Duration of CTG recording (for at least 20 minutes if over 28w gestation) [B]	13
Ultrasound scan for fetal biometry and umbilical artery Doppler if clinically deemed to be at risk of stillbirth (within 24 h) [B]	30
Ultrasound scan for fetal morphology (if not already done) [A]	7
A selective role for fetal biophysical profile [B]	11
Ultrasound scan for fetal biometry and umbilical artery Doppler in all women with recurrent presentation [B]	53
Women should be reassured that 70% of pregnancies with a single episode of RFM are uncomplicated [C]	46
Avoid the use of kick charts (formal fetal movement counting) [A]	77

Grade of evidence in RCOG guideline is shown in square brackets: [A] At least one high-quality meta-analysis, systematic review or randomised controlled trial with very low risk of bias; [B] A body of evidence including high-quality systematic reviews of case-control or cohort studies or high-quality case–control or cohort studies with a very low risk of confounding, bias or chance and a high probability that are applicable to the target population, and demonstrating overall consistency of results; [C] A body of evidence including well-conducted case–control or cohort studies with a low risk of confounding, bias or chance, directly applicable to the target population and demonstrating overall consistency of results or extrapolated evidence from high-quality systematic reviews, or case-control or cohort studies; GPP = Good Practice Point [18].

ISSN: 1471-2393