Fetal and maternal surveillance in high-risk pregnancy: tools, timing, and trends

According to WHO statistics, stillbirths represent an incompletely elucidated, partially neglected problem, resulting in millions of pregnancies per year globally. This phenomenon has a major emotional impact on parents and society, as well as an additional economic effort on the part of health services. Stratification of high-risk pregnancies could be followed by a decrease in perinatal mortality through careful monitoring and possible obstetric interventions in selected cases. Identification of risk factors, assessment of genetic causes, planning of imaging monitoring strategy, cardiotocography, and therapeutic management can contribute to a decrease in the number of stillbirths. In this narrative review, we aimed to assess the current status of fetal and maternal surveillance in high-risk pregnancies and the role of identifying fetal movements associated with the risk of stillbirth. Recommendations for routine monitoring of fetal movement are warranted in high-risk pregnancies, particularly those with placental pathology or small for gestational age (SGA)/FGR (fetal growth restriction) assessed by ultrasound or by analysis of various biomarkers. Current methods for fetal movement counting do not demonstrate high sensitivity and specificity, underscoring the need for further research. Identifying the main risk factors for stillbirth and stratifying fetuses at high risk will contribute to improving mater-nal-fetal outcomes and better management of health system resources.