Fetal movement counting for assessment of fetal wellbeing

  • Review
  • Intervention


  • Lindeka Mangesi,

    Corresponding author
    1. Eastern Cape Department of Health, Epidemiological Research and Surveillance Management Directorate, Bisho, South Africa
    • Lindeka Mangesi, Epidemiological Research and Surveillance Management Directorate, Eastern Cape Department of Health, Private Bag X0038, Bisho, 5605, South Africa. lin.mangesi@gmail.com.

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  • G Justus Hofmeyr,

    1. University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health, Department of Obstetrics and Gynaecology, East London Hospital Complex, East London, Eastern Cape, South Africa
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  • Valerie Smith

    1. Trinity College Dublin, School of Nursing and Midwifery, Dublin, Ireland
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Fetal movement counting is a method by which a woman quantifies the movements she feels to assess the condition of the baby. The purpose is to try to reduce perinatal mortality by alerting caregivers when the baby might have become compromised. This method may be used routinely, or only in women who are considered at increased risk of complications in the baby. Some clinicians believe that fetal movement counting is a good method as it allows the clinician to make appropriate interventions in good time. On the other hand, fetal movement counting may cause anxiety to women.


To assess outcomes of pregnancy where fetal movement counting was done routinely, selectively or was not done at all; and to compare different methods of fetal movement counting.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2006), the Cochrane Central Register of Controlled Trials (The Cochrane Library) and the reference lists of relevant papers. We updated the search of the Cochrane Pregnancy and Childbirth Group's Trials Register on 8 June 2012and added the results to the awaiting classification section.

Selection criteria

Randomised controlled trials. Trials were excluded where allocation concealment was inadequate and no measures were taken to prevent bias. The interventions included routine fetal movement counting, selective fetal movement counting, and studies comparing different fetal assessment methods.

Data collection and analysis

We assessed the methodological quality of included studies and extracted data from studies.

Main results

Four studies, involving 71,370 women, were included in this review; 68,654 in one cluster-randomised trial. All four trials compared formal fetal movement counting. Two trials compared different types of counting with each other; one with no formal instruction, and one with hormonal analysis. Women in the formal fetal movement counting group had significantly fewer visits to the hospital antenatally than those women randomised to hormone analysis (relative risk (RR) 0.26, 95% confidence interval (CI) 0.20 to 0.35), whereas there were fewer Apgar scores less than seven in five minutes for women randomised to hormone analysis (RR 1.72, 95% CI 1.01 to 2.93).

There was a significantly higher compliance with Cardiff 'count to ten' (once a day) method than the fetal movement counting method where women were counting 30 minutes before meals and at bedtime (more than once a day).

All other outcomes reported were non significant.

Authors' conclusions

This review does not provide enough evidence to influence practice. In particular, no trials compared fetal movement counting with no fetal movement counting. Robust research is needed in this area.

[Note: the four citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.]

Plain language summary

Fetal movement counting for assessment of fetal wellbeing

Not enough evidence on counting the baby's movements in the womb to check for wellbeing.

Mothers can usually feel their babies moving in their wombs from around 16 to 20 weeks. Babies' activities in the womb can vary considerable, some being very active and some not. A decrease in a baby's normal pattern of movements may be a sign that the baby is struggling for some reason and it might be better for the baby to be born early. Hence, it has been suggested that if the mother counts her babies' movements each day, and there are several ways of doing this, she may be able to identify a decrease in her baby's normal movement patterns. It is further suggested that if the mother informs caregivers of this, then the caregivers can do additional tests and some babies can be prevented from dying before birth. However, sometimes fetal movement-counting tests can cause considerable anxiety for women and may not be easy for some women especially when a mother is busy at work or caring for other small children, so it is important to assess if these tests are effective in identifying babies in difficulties with time to intervene. The review of trials found four studies, involving 71,370 women, comparing two fetal movement counting methods, fetal movement counting and hormonal analysis and the one that compared routine fetal movement counting with selective fetal movement counting. The trials identified no advantages but the numbers and the methodological quality of studies were insufficient to assess stillbirths accurately. Further trials are suggested, and it would be very important to assess women's anxieties and views in addition to the ability of the counting to prevent unexplained stillbirths.