Fetal Movements

Question 1

When does first fetal movement occur?

Answer 1

Known as quickening - usually occurs between 18-20 weeks gestation, and increase until 32 weeks gestation at which point the frequency of movement tends to plateau.

Multiparous women will usually experience fetal movements sooner, from 16-18 weeks gestation. Towards the end of pregnancy, fetal movements should not reduce.

Question 2

At what point are fetal movements a concern?

Answer 2

Less than 10 movements in 2 hours in pregnancies past 28 weeks gestation.

Question 3

Describe epidemiology of reduced fetal movements?

Answer 3

Affects up to 15% of pregnancies - 3-5% will have recurrent episodes.

Question 4

What are RFs for reduced fetal movements?

Answer 4

1. Posture - reduced awareness of fetal movements, more prominent when lying down and less when sitting/standing
2. Maternal Distraction
3. Placental position - anterior placentas prior to 28 weeks gestation may have lesser awareness of fetal movements
4. Medication - Both alcohol and sedative medications like opiates or benzodiazepines can temporarily cause reduced fetal movements
5. Fetal position - Anterior fetal position means movements are less noticeable
6. Body habitus - Obese patients are less likely to feel prominent fetal movements
7. Amniotic fluid volume - Both oligohydramnios and polyhydramnios can cause reduction in fetal movements
8. Fetal size - Small fetus is more likely to have RFM

Question 5

How can fetal movements be objectively assessed?

Answer 5

handheld Doppler or ultrasonography

Question 6

How should RFM be managed?

Answer 6

1. If past 28 weeks gestation:
   Initially, handheld Doppler should be used to confirm fetal heartbeat - if no fetal heartbeat detectable, immediate ultrasound should be offered.
   If fetal heartbeat present, CTG should be used for at least 20 minutes to monitor fetal heart rate which can assist in excluding fetal compromise.
   If concern remains, despite normal CTG, urgent (within 24 hours) ultrasound can be used. Ultrasound assessment should include abdominal circumference or estimated fetal weight (to exclude SGA), and amniotic fluid volume measurement

If between 24 and 28 weeks gestation, a handheld Doppler should be used to confirm presence of fetal heartbeat.

If below 24 weeks gestation, and fetal movements have previously been felt, a handheld Doppler should be used.

If fetal movements have not yet been felt by 24 weeks, onward referral should be made to a maternal fetal medicine unit.

Question 7

What is the prognosis of RFM?

Answer 7

Concern regarding absent or reduced fetal movements stems for the potential for this presentation to represent fetal distress or impending demise.

40-50% of women with stillbirth experience RFM

In 70% of pregnancies with a single episode of reduced fetal movement, there is no onward complication