Clinical utility of inpatient monitoring for reduced fetal movements in the absence of fetal pathology

Abstract Background Evidence on the follow-up of women with reduced fetal movements (RFM) and physiological fetal parameters at initial assessment is limited. We evaluated whether inpatient monitoring provides additional clinical value in this population. Material and methods In this retrospective study, women with a first episode of RFM and physiological fetal assessment (by means of cardiotocography, single deepest vertical pocket, estimated fetal weight, and umbilical artery Doppler) between January 2017 and December 2025 were identified and their clinical course and inpatient monitoring was analyzed. Patients with fetal pathology, recurrent RFM, or multiple gestation were excluded. Clinical outcomes were compared with a matched control cohort. Results Of 154 identified cases with RFM, 78 women met our inclusion criteria. Median gestational age was 36 + 2 weeks (IQR 33 + 0–37 + 5) and median hospital stay 1.5 days (IQR 1–2). In 74 (94.87%) patients, inpatient monitoring yielded no additional findings and did not change management; in 4 (5.13%) cases, changes in the clinical course occurred, but were attributable to independent obstetric factors (hypertension, premature rupture of membranes, impending uterine rupture, recurrent RFM). No distinct differences in birth outcomes between patients with RFM and controls were observed. Conclusion In women presenting with RFM and no evidence of fetal compromise, inpatient monitoring rarely influenced clinical management. Outpatient follow-up with counselling may be a feasible alternative pending further validation.