A Cochrane review [Abstract] 1 included 5 studies involving a total of 71 458 women (68 654 in one cluster-randomised trial). Two trials compared different types of counting with each other, one with no formal instruction, and one with hormonal analysis. In one large cluster-RCT, there was no difference in mean stillbirth rates per cluster (standard mean difference (SMD) 0.23, 95% CI -0.61 to 1.07; 52 clusters; low quality evidence). The other study reported no fetal deaths. There was no difference in caesarean section rate between groups (RR 0.93, 95% CI 0.60 to 1.44; 1 trials, n=1076; low quality evidence). In another there was a trend to more antenatal admissions per cluster in the counting group than in the control group (SMD 0.38, 95% CI -0.17 to 0.93; 52 clusters; low quality evidence). The formal fetal movement counting group had fewer visits to the hospital antenatally than the hormone analysis group (RR 0.26, 95% CI 0.20 to 0.35), whereas there were no difference in caesarean sections rates. The incidence of caesarean section did not differ between the groups formal fetal movement counting once a day (count-to-10) versus formal fetal movement counting more than once a day (after meals). No trials compared fetal movement counting with no fetal movement counting on perinatal outcome.
A meta-analysis 2 included 5 trials with 468 601 fetuses. In 4 studies, women in the intervention group were asked to contact their health care providers if they perceived decreased fetal movement, which usually resulted in electronic fetal monitoring and ultrasound assessment of fetal well-being. There was no difference in the incidence of perinatal outcome between groups. The incidence of perinatal death was 0.54% in the fetal movement counting group and 0.59% in the control group (RR 0.92, 95% CI 0.85 to 1.00). There were no statistical differences for other perinatal outcomes as stillbirths, neonatal deaths, birth weight less than 10th percentile, reported decreased fetal movement, 5-minute Apgar score less than 7, neonatal intensive care unit admission or perinatal morbidity. There were weak but significant increases in preterm delivery (7.6% vs 7.1%; RR 1.07, 95% CI 1.05 to 1.10), induction of labor (36.6% vs 31.6%; RR 1.15, 95% CI 1.09 to 1.22), and cesarean delivery (28.2% vs 25.3%; RR 1.11, 95% CI 1.10 to 1.12).
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and blinding) and by imprecise results.
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