8A) Antenatal Care: Reduced fetal movements

Question 1

Risk of stillbirth in general population

Answer 1

<1 in 250

Question 2

Describe FM

Answer 2

Any discrete kick, swish, flutter or roll.

Question 3

When are FM first perceived?

Answer 3

18-20 weeks

Question 4

What is the change in FM over the course of the pregnancy?

Answer 4

Plateau at 32 weeks but no reduction.

Question 5

What percentage of women who experience a stillbirth report DFM prior?

Answer 5

55%

Question 6

What is the average number of movements per hour at term and the longest period between them?

Answer 6

Average 31 movements per hour with maximum 60 minutes between movements.

Question 7

When might an anterior placenta affect perception of FM?

Answer 7

Prior to 28+0

Question 8

What percentage of pregnancies with a single episode of DFM are uncomplicated?

Answer 8

70%

Question 9

Management of DFM prior to 24 weeks

Answer 9

Auscultation FH.

If never felt FM by 24/40 - refer FMU.

Question 10

Management of DFM 24-28 weeks

Answer 10

Auscultation FH.

Question 11

Management of DFM >28 weeks

Answer 11

1. Confirm history of DFM - if not convincing then auscultation FH, reassure and advise re: if not happy with FM to pay attention for 2 hours and if not felt more than 10 movements to seek advice.

Once history of DFM confirmed - auscultation FH, then CTG, then if CTG normal and patient reassured and no risk factors then home with above advice. If CTG normal but patient not reassured or has risk factors then scan for growth and liquor.