“CPR” For Decreased Fetal Movement? The CEPRA Trial
Sep 23, 2025
Maternal concerns about decreased fetal movement can be alarming, affecting up to 15% of pregnancies. The podcast delves into why routine labor induction isn't recommended solely for this issue. The discussion highlights the cerebroplacental ratio (CPR) as a potential ultrasound tool for assessing fetal well-being and early placental insufficiency. The results of the CEPRA trial suggest the CPR could influence clinical practice, though caution is advised since routine induction may not improve outcomes. Practical guidance is emphasized throughout.
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question_answer ANECDOTE
Real Case: Recurrent Reports At 37 Weeks
Dr. Chapa described a patient who repeatedly presented at 37 weeks with decreased fetal movement despite normal testing.
The team repeatedly reassured the patient and continued surveillance rather than induce early.
volunteer_activism ADVICE
Always Assess Decreased Fetal Movement
Do evaluate any report of decreased fetal movement with a non-stress test and a fluid check (modified BPP).
Continue surveillance for recurrent concerns but avoid routine induction before 39 weeks without another indication.
volunteer_activism ADVICE
Don’t Induce Before 39 Weeks For Kicks Alone
Avoid routine induction solely for decreased fetal movement in otherwise low-risk pregnancies under 39 weeks.
Explain that early induction can increase neonatal respiratory morbidity and NICU admission.
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Maternal perception of decreased fetal movement at term occurs in up to 15% of pregnancies and is a cause for maternal and provider concern. All maternal concerns of decreased fetal movement require an assessment of fetal wellbeing. But what about the patient with recurrent episodes of reduced fetal movements at term? Routine induction of labor is not supported solely for decreased fetal movement in a non-growth-restricted fetus, as increased intervention rates (including induction of labor and early term birth) have not demonstrated improved perinatal outcomes and may increase neonatal morbidity, such as respiratory distress and NICU admission. Some international sources (ISUOG) have recognized the cerebroplacental ratio (CPR) as a possible ultrasound tool to investigate possible early placental insufficiency before fetal growth restriction occurs. Is CPR helpful for decreased fetal movements at term? A new publication from the Lancet’s new journal- Obstetrcis, Gynecology, and Women’s Health- states that it is. Is the CPR ultrasound assessment recognized by the ACOG or SMFM? Listen in for details.
1. The cerebroplacental ratio: a useful marker but should it be a screening test? (2025): https://obgyn.onlinelibrary.wiley.com/doi/10.1002/uog.29154#:~:text=The%20ISUOG%20guidelines%20recommend%20using,after%2038%20weeks'%20gestation44.
2. Turner JM, Flenady V, Ellwood D, Coory M, Kumar S.Evaluation of Pregnancy Outcomes Among Women With Decreased Fetal Movements.JAMA logoJAMA Network Open. 2021;4(4):e215071. doi:10.1001/jamanetworkopen.2021.5071.
3. Cerebroplacental ratio-based management versus care as usual in non-small-for-gestational-age fetuses at term with maternal perceived reduced fetal movements (CEPRA): a multicentre, cluster-randomised controlled trial. https://www.sciencedirect.com/science/article/pii/S3050503825000020
4. Hofmeyr GJ, Novikova N. Management of Reported Decreased Fetal Movements for Improving Pregnancy Outcomes. The Cochrane Database of Systematic Reviews. 2012;(4):CD009148. doi:10.1002/14651858.CD009148.pub2.
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