***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Fetal movement counting has long been suggested as a screening tool to identify impaired placental function . However , quantitative limits for decreased fetal movement perform poorly for screening purpose s , indicating the need for method ological refinement . We aim ed to identify the main individual temporal patterns in fetal movement counting charts , and explore their associations with pregnancy characteristics . Methods In a population -based prospect i ve cohort in Norway , 2009–2011 , women with singleton pregnancies counted fetal movements daily from pregnancy week 24 until delivery using a modified " count-to-ten ” procedure . To account for intra-woman correlation of observations , we used functional data analysis and corresponding functional principal component analysis to identify the main individual temporal patterns in fetal movement count data . The temporal patterns are described by continuous functional principal component ( FPC ) curves , with an individual score on each FPC for each woman . These scores were later used as outcome variables in multivariable linear regression analyses , with pregnancy characteristics as explanatory variables . Results Fetal movement charts from 1086 pregnancies were included . Three FPC curves explained almost 99 % of the variation in the temporal data , with the first FPC , representing the individual overall counting time , accounting for 91 % alone . There were several statistically significant associations between the FPCs and various pregnancy characteristics . However , the effects were small and of limited clinical value . Conclusions This statistical approach for analyzing fetal movement counting data successfully captured clinical ly meaningful individual temporal patterns and how these patterns vary between women . Maternal body mass index , gestational age and placental site explained little of the variation in the temporal fetal movement counting patterns . Thus , a perceived decrease in fetal movement should not be attributed to a woman ’s basic pregnancy characteristics , but assessed as a potential marker of risk This study assessed the effect of foetal movement counting on  maternal anxiety . In a r and omised , controlled trial , 208 primigravida women with a singleton pregnancy were allocated either to perform daily foetal movement counting ( n = 100 ) from 28 weeks ’ gestation or to follow st and ard Iranian antenatal care ( n = 108 ) . Maternal anxiety was measured by Spielberger State-Trait Anxiety Inventory . Statistical analysis was performed by SPSS ( 16.0 ) . There was no significant difference in mean state and trait anxiety scores at 28 weeks ’ gestation ; the difference was significant at 37 weeks ’ gestation in state anxiety score between the intervention and control groups ( 35.34 ± 9.98 vs. 38.25 ± 9.63 , respectively , P < 0.001 ) . A significant difference was found in mean trait anxiety score at 37 weeks ’ gestation between the two groups ( 35.88 ± 8.19 vs. 39.15 ± 9.25 , respectively , P = 0.008 ) . Women who performed foetal movement counting from 28 to 37 weeks ’ gestation reported less anxiety compared with those in control group Background Delayed maternal reporting of decreased fetal movement ( DFM ) is associated with adverse pregnancy outcomes . Inconsistent information on fetal activity to women during the antenatal period may result in delayed reporting of DFM . We aim ed to evaluate an intervention of implementation of uniform information on fetal activity to women during the antenatal period . Methods In a prospect i ve before- and -after study , singleton women presenting DFM in the third trimester across 14 hospitals in Norway were registered . Outcome measures were maternal behavior regarding reporting of DFM , concerns and stillbirth . In addition , cross-sectional studies of all women giving birth were undertaken to assess maternal concerns about fetal activity , and population -based data were obtained from the Medical Birth Registry Norway . Results Pre- and post-intervention cohorts included 19 407 and 46 143 births with 1 215 and 3 038 women with DFM respectively . Among primiparous women with DFM , a reduction in delayed reporting of DFM ( ≥48 hrs ) OR 0.61 ( 95 % CI 0.47 - 0.81 ) and stillbirths OR 0.36 ( 95 % CI 0.19 - 0.69 ) was shown in the post-intervention period . No difference was shown in rates of consultations for DFM or maternal concerns . Stillbirth rates and maternal behavior among women who were of non-Western origin , smokers , overweight or > 34 years old were unchanged . Conclusions Uniform information on fetal activity provided to pregnant women was associated with a reduction in the number of primiparous women who delayed reporting of DFM and a reduction of the stillbirth rates for primiparous women reporting DFM . The information did not appear to increase maternal concerns or rate of consultation . Due to different imperfections in different clinical setting s , further studies in other population s replicating these findings are required Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background Fetal movement counting is a method used by the mother to quantify her baby 's movements , and may prevent adverse pregnancy outcome by a timely evaluation of fetal health when the woman reports decreased fetal movements . We aim ed to assess effects of fetal movement counting on identification of fetal pathology and pregnancy outcome . Methodology In a multicentre , r and omized , controlled trial , 1076 pregnant women with singleton pregnancies from an unselected population were assigned to either perform fetal movement counting from gestational week 28 , or to receive st and ard antenatal care not including fetal movement counting ( controls ) .  Women were recruited from nine Norwegian hospitals during September 2007 through November 2009 . Main outcome was a compound measure of fetal pathology and adverse pregnancy outcomes . Analysis was performed by intention-to-treat . Principal Findings The frequency of the main outcome was equal in the groups ; 63 of 433 ( 11.6 % ) in the intervention group , versus 53 of 532 ( 10.7 % ) in the control group [ RR : 1.1 95 % CI 0.7–1.5 ) ] . The growth-restricted fetuses were more often identified prior to birth in the intervention group than in the control group ; 20 of 23 fetuses ( 87.0 % ) versus 12 of 20 fetuses ( 60.0 % ) , respectively , [ RR : 1.5 ( 95 % CI 1.0–2.1 ) ] . In the intervention group two babies ( 0.4 % ) had Apgar scores < 4 at 1 minute , versus 12 ( 2.3 % ) in the control group [ RR : 0.2 ( 95 % CI 0.04–0.7 ) ] . The frequency of consultations for decreased fetal movement was 71 ( 13.1 % ) and 57 ( 10.7 % ) in the intervention and control groups , respectively [ RR : 1.2 ( 95 % CI 0.9–1.7 ) ] . The frequency of interventions was similar in the groups . Conclusions Maternal ability to detect clinical ly important changes in fetal activity seemed to be improved by fetal movement counting ; there was an increased identification of fetal growth restriction and improved perinatal outcome , without inducing more consultations or obstetric interventions . Trial Registration Clinical Trials.gov By identifying a change in fetal activity state , fetal movement counting may help to reduce the possibility of stillbirth . Concern has arisen that such a focus on fetal activity may cause undue maternal anxiety . A prospect i ve , controlled trial was conducted to determine whether fetal movement counting induced anxiety or other deleterious psychological effects in low-risk primigravidas . A sample of 613 healthy pregnant women was r and omly assigned at 28 weeks ' gestation to fetal movement counting , sleep recording , or a nonrecording control group .  State and trait of anxiety , belief in sources of personal control , and attitudes toward pregnancy and infant were assessed at 28 and 37 weeks ' gestation . Participation rates were high ( 91.4 % ) across all groups . Most women ( 90 % ) assigned to count fetal movements did so on a daily basis ( 95 % of days ) . No significant changes in psychological status occurred in the three groups as a result of self-monitoring conditions . Independent of group assignment , all women showed a slight increase in transient state and decrease in trait of anxiety from 28 to 37 weeks . Internal locus of control and positive attitudes toward the infant increased slightly , and feelings of well-being decreased slightly for all women . It was concluded that women are willing to record fetal activity , and that fetal movement counting does not cause deleterious psychological effects in low-risk pregnant women The effect of fetal movement counting on maternal attachment to fetus was investigated in 213 women with uncomplicated singleton pregnancies at 28 to 32 weeks ' gestation . Women were r and omized into those who counted fetal movements using the Sadovsky ( n = 63 ) or Cardiff ( n = 62 ) charts and controls ( n = 88 ) . After 1 month of fetal movement counting , the Cranley 24-item scale with five subscales was used as a measure of maternal-fetal attachment . Univariate analysis revealed a statistically significant increase in total attachment scores and in each of the five attachment subscales among women who counted fetal movements ( p less than 0.0001 ) . Turkey 's studentized range test confirmed significant differences between each of the Sadovsky and Cardiff groups compared with controls ( p less than 0.05 ) . Our study suggests that fetal movement counting may enhance the maternal-fetal attachment process Objective : To compare two daily fetal movement charting techniques to determine which chart was preferred by patients and which promoted more patient adherence . Methods : This r and omized trial included patients with singleton gestations between 28 and 34 weeks ' gestation , with intact membranes and not in labor . Consenting women were given a Hollister ® chart and a ' count to 10 ' chart in a cross-over manner over two consecutive 1-week periods . Each patient answered a question naire establishing which chart was preferred . All returned charts were evaluated for patient adherence . Data were analyzed using either the Yates-corrected χ2 test or Fisher 's exact test when appropriate . Results : Forty patients agreed to participate , and 31 completed and returned both charts . The  ' count to 10 ' chart was clearly preferred over the Hollister chart ( 29 vs. 2 ; p = 0.002 ) because of the shorter recording period ( median 23 min vs. 1 h ; p < 0.01 ) . The proportion of patients who fully completed the ' count to 10 ' chart during the week was significantly higher than the proportion completing the Hollister chart ( 68 % vs. 26 % ; p < 0.001 ) . Conclusion : The  ' count to 10 ' fetal movement chart was clearly preferred and promoted a higher level of adherence An active fetus is reassuring to both the woman and her obstetrician . Numerous techniques of charting fetal movement have been shown to assist the clinician in caring for the high-risk patient . Patients ' compliance with daily monitoring is an important clinical issue , and little information exists on the fetal movement record most preferred by the patient . A comparative study evaluated patients ' acceptance of three commonly used charts . The 85 enrollees were given the different charts in a r and om manner and question ed at the next office visit . All the patients expressed approval of the concept and a lack of anxiety about such monitoring , complied with our instructions and returned the completed records . The neonatal outcomes were favorable with all the charting techniques in our antenatal fetal surveillance plan . The  " count-to-10 " method  was rated most preferred in 95.3 % of the cases . The reasons cited included convenience and less time needed to complete the recording . The mean time to complete this record was 19.7 + /- 22.9 minutes rather than one or more hours , as with the other charting methods . The results of this r and omized investigation show the simple and rapid count-to-10 method to be the most acceptable charting technique to our patients for monitoring fetal movement Objective . ‘ Normal ’ fetal activity is recognized as a sign of fetal well‐being and concerns for decreased fetal movements is a frequent cause of non‐scheduled antenatal visits . The aim of this study was to identify maternal characteristics in women presenting decreased fetal movements in a total population , to identify the risk of adverse outcomes and assess the management provided . Design . Prospect i ve population ‐based cohort . Setting . Fourteen delivery units in Norway . Population . A total of 2,374 pregnancies presenting with a perception of decreased fetal movements and 614 control/referent cases . Methods . All singleton third trimester pregnancies presenting with a perception of decreased fetal movements were registered from June 2004 through October 2005 . Pregnancies never examined for this condition were collected as a cross‐sectional sample from the same population . Main outcome measures . Fetal growth restriction , preterm birth and stillbirth . Results . Mothers with  decreased fetal movements  were more often smokers , overweight and primiparous . Of the women , 32 % presented with perceived absence of fetal movements , of whom 25 % waited for more than 24 hours without any movements . Abnormal findings were identified in 16 % of examinations . Decreased fetal movements were associated with adverse pregnancy outcome in 26 % , including preterm birth and fetal growth restriction . An intervention or repeated consultations were performed in 41 % of cases , including 14 % admissions to maternity ward . None of the included hospitals had written guidelines for management . Conclusions . A perception of decreased fetal movements is significantly associated with adverse pregnancy outcome such as preterm birth , fetal growth restriction and stillbirth . Guidelines for management and information to pregnant women are needed Fetal death is a tragedy for mother , family , and obstetrician . Recent review s of fetal death 
    Output:
    
We found no evidence of increased maternal concern following interventions .
We found no clear evidence of benefit or harm ; indirect evidence suggests improved pregnancy and birth outcomes .
TWEETABLE ABSTRACT The benefits and risks of interventions to increase pregnant women 's awareness of fetal movement are unclear