Decreased Fetal Movements

Question 1

When does maternal perception of fetal movements tend to commence?

Answer 1

16-20/40

Question 2

Do the number of fetal movements decrease as a pregnancy advances, or prior to the onset of labour?

Answer 2

No

Question 3

Women perceive most fetal movements in what position?

Answer 3

Lying down
Fewer when sitting
Fewest while standing

GTG

Question 4

Prior to ___/40, an anteriorly positioned placenta may decrease a woman’s perception of fetal movements

Answer 4

28/40

GTG

Question 5

With RFM, USS for fetal biometry and AFI should be considered as part of the preliminary investigations and undertaken within ____ hours

Answer 5

24

In a prospective study of 3014 women, detection of an abnormality on USS was reported in 11.6%. The CTG was abnormal in only 3.2% cases

Question 6

With RFM <28/40, when should USS be taken?

Answer 6

RFM persists

Additional risk factors for IUGR / Stillbirth

Preferably within 24 hours

Question 7

____% of pregnancies with a single episode of RFM are uncomplicated

Answer 7

70%

Question 8

Decreased fetal movements is linked to adverse perinatal outcomes such as

Answer 8

Neurodevelopmental delay
Infection
FM haemorrhage
Emergency delivery
Umbilical cord complications
SGA and FGR
PTB, TPTL
Congenital malformations, chromosomal abnormalities
Low APGAR scores and acid anemia
Hypoglycaemia
Stillbirths and neonatal deaths
Placental dysfunction

Question 9

What was the method and results of the AFFIRM Trial?

2018
Lancet

Answer 9

Randomised to usual care or RFM care package

Care package

• CTG within 2 hours
• Measurement of liquor within 12 hours
• Growth scan on next working day (unless done in the past 3/52)
• encouraged to use UAPI in addition to growth when possible
• deliver recommended for women who were at least 37/40 in context of SGA, oligohydramnios, abnormal CTG or recurrent RFM

Primary outcome: incidence of stillbirth

Conclusion: The RFM care package did not reduce the risk of stillbirths

Question 10

Define perceived fetal movements

Answer 10

Fetal movements defined as any discrete kick, flutter, swish or roll

Question 11

Describe the normal maternal perception of fetal movements through pregnancy

Answer 11

Onset of movements at 16-20/40
Diurnal pattern (peak in afternoon and evening)
Tend to plateau at 32/40
In third trimester, type of movement may change but frequency does not

Question 12

The FHR accelerates with ______% of all gross body movements felt by the mother

Answer 12

92-97%