Investigating the significance and current state of knowledge and practice of absent or reduced fetal movements in low and lower middle-income countries: a scoping review

Abstract

# Background Absent or reduced fetal movements (ARFM) are linked to adverse perinatal outcome in high income countries but the significance of this symptom in low and lower middle income countries (LMICs) is less established. The objective of this study was to report the current state of knowledge and practice regarding the association between ARFM and adverse pregnancy outcomes in LMICs. # Methods Systematic literature searches were undertaken in MEDLINE, Web of Science, Google Scholar, LILACS, and AJOL. Studies were included if they reported adverse perinatal outcome(s) following ARFM, clinical management strategies employed following ARFM, or women's knowledge regarding perception of ARFM. Qualitative data were tabulated, where possible meta-analysis was performed on quantitative data. # Results Nineteen full-text papers were included; five studies reported the association between ARFM and stillbirth in LMICs (1466 pregnancies including 296 stillbirths). The likelihood of stillbirth was higher in ARFM (odds ratio 14.13, 95% CI 3.46-57.77). Women's awareness of ARFM as a danger sign varied greatly from 3.1-62.3%. # Conclusions There is a lack of published literature regarding the significance of ARFM in LMICs, but available data suggest a significant association between ARFM and adverse outcomes. Strategies to increase women's awareness require evaluation in LMICs.