Maternal Recognition of Ultrasound-Observed Fetal Movements Among Pregnancies in the Third Trimester: Concordance, Directional Discrepancies, and Associated Factors

Background and Objectives: Maternal perception of fetal movement is widely used to monitor fetal activity; however, maternally perceived movements may not correspond directly to movements observed by ultrasonography. This study aimed to quantify same-window maternal recognition of ultrasound-observed fetal movements, characterize temporal concordance and directional discrepancies, and examine associated maternal and pregnancy-related factors. Materials and Methods: Pregnant women at ≥28 weeks of gestation underwent simultaneous 20 min fetal-movement assessment using real-time ultrasonography and maternal button-press reporting. The ultrasound observer pressed a designated button whenever fetal movement was visually observed, while participants independently pressed a separate button whenever they perceived fetal movement. Both responses were electronically timestamped using the same system clock and segmented into consecutive 5 s windows. Windows containing an ultrasound-observer button press were classified as ultrasound-positive, and those accompanied by a maternal response within the corresponding window were classified as temporally matched. Same-window maternal recognition was defined as the proportion of ultrasound-positive windows accompanied by a maternal response within the same 5 s analytical window. Associated factors were examined using fractional logistic regression with robust standard errors.