(427) Delivery and neonatal outcomes associated with delivery versus expectant management following term decreased fetal movement

This was a retrospective cohort study of patients with singleton gestations delivering at a large hospital system from 2013-2023. Using electronic medical records, patients presenting with the chief complaint of DFM at >37 weeks gestation were identified. Using timestamps, latency between DFM presentation and delivery admission was calculated. Patients were grouped into 3 categories: 1) < 24 hours, 2) 24-48 hours, 3) >48 hours. For patients who presented with DFM more than once beyond 37 weeks, the presentation most proximal to delivery was used. Comparisons across the categorical measure of time to admission were performed using chi-square tests or Fisher’s exact tests as appropriate for categorical variables and means and standard deviations were compared using analysis of variance (ANOVA) test for continuous variable.

Results:

Of the 2,015 patients, 193 (9.6%) were admitted for delivery at < 24 hours, 131 (6.5%) between 24-48 hours, and 1,691 (83.9%) at >48 hours. The mean gestational ages at presentation for DFM were 39w3d +/- 7.0 days (< 24h group), 39w3d +/- 7.0 days (24-48h group), and 38w4d +/- 6.7 days ( >48h group). The mean gestational ages at delivery were 39w4d +/- 7.1 days (< 24h group), 39w5d +/- 7.0 days (24-48h group), and 40w0d +/- 6 days ( >48h group). There were no cases of stillbirth or neonatal demise. There were no significant differences in mode of delivery, rates of induction of labor, infectious or hemorrhagic maternal morbidities, or maternal length of stay by timing of delivery admission from DFM presentation. Neonatal outcomes were also similar such as birthweight and NICU admission (Table).

Conclusion: Among patients presenting with DFM to triage at term, expectant management with delivery beyond 48 hours was not associated with adverse perinatal outcomes as compared to admission for delivery within 24 hours or 24-48 hours.