A Cochrane review included 5 studies involving a total of 71 458 women (68 654 in one cluster-randomised trial). Two trials compared different types of counting with each other, one with no formal instruction, and one with hormonal analysis. In one large cluster-RCT, there was no difference in mean stillbirth rates per cluster (standard mean difference (SMD) 0.23, 95% CI -0.61 to 1.07; 52 clusters; low quality evidence). The other study reported no fetal deaths. There was no difference in caesarean section rate between groups (RR 0.93, 95% CI 0.60 to 1.44; 1 trials, n=1076; low quality evidence). In another there was a trend to more antenatal admissions per cluster in the counting group than in the control group (SMD 0.38, 95% CI -0.17 to 0.93; 52 clusters; low quality evidence). The formal fetal movement counting group had fewer visits to the hospital antenatally than the hormone analysis group (RR 0.26, 95% CI 0.20 to 0.35), whereas there were no difference in caesarean sections rates. The incidence of caesarean section did not differ between the groups formal fetal movement counting once a day (count-to-10) versus formal fetal movement counting more than once a day (after meals). No trials compared fetal movement counting with no fetal movement counting on perinatal outcome.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and blinding), by imprecise results, and by inconsistency (heterogeneity in interventions).