Should we stop telling well pregnant women to monitor fetal movements? How to use and interpret guidelines

[Extract] THE confusion articulated in the commentary by Hill-Smith1 is interesting on several levels. Is this an example of the mess that evidence-based medicine (EBM) can get us into? It certainly raises the thorny issue of how research conducted in one place and time could usefully assist us in clinical practice in another setting. It also calls into question what good guidelines should look like.

Hill-Smith wonders whether we should ask women to routinely keep a fetal movement diary (‘kick chart’). The NICE (National Institute of Clinical Excellence) guidelines suggest not — kick charts make no difference to infant mortality.2 But there is a rider: one baby may be saved for every 1250 women routinely using kick charts. These two statements appear contradictory.