2011 57 Reduced Fetal Movements Flashcards
What proportion of women with a stillbirth experience reduced fetal movements prior to diagnosis?
55%
How do fetal movements usually change in the 3rd trimester?
- Plateau at 32/40
- Type of movement changes
- Frequency of movements should not decrease
How long do fetal sleep cycles generally last?
20-40 mins
Rarely exceed 90 mins
What factors can influence maternal perception of fetal movements?
- Maternal position: lying best, fewer sitting, fewest standing
- Busyness & distractions
- Anterior placenta
- Fetal position: anterior spine
What factors may reduce fetal movements?
- Sedating drugs
- Corticosteroids (not proven)
- Fetal malformations
- Abnormalities of CNS, muscles & skeleton
What should women do if they are a) concerned, b) unsure if fetal movements are reduced?
a) contact maternity unit
b) lie on left side & focus on fetal movements for 2 hours; contact if <10
How should women with reduced fetal movements be assessed?
- History
- Examination, including Doppler
- CTG if > 28/40
- Ultrasound for fetal growth
What features should be included in a reduced fetal movements history?
- Reduction or absence
- Duration
- Number of occasions
- Risk factors for stillbirth & FGR
What are the risk factors for stillbirth?
- Multiple presentations with RFM
- Known FGR
- Hypertension
- Diabetes
- Extremes of maternal age
- Primiparity
- Smoking
- Congenital malformations
- Obesity
- Racial factors
- Poor past obstetric history
- Genetic factors
- Issues with access to care
What is the risk of stillbirth in the UK?
< 1:250
What does a normal CTG indicate?
Healthy fetus
Properly functioning autonomic nervous system
What proportion of pregnancies with a single episode of reduced fetal movements are uncomplicated?
70%
What should be done in reduced fetal movements prior to 24/40?
- Doppler auscultation
- If no FMs ever felt by 24/40, consider FMU for neuromuscular assessment
