GTG 57: Reduced Foetal Movements

Question 1

When do women start to feel foetal movements?

Answer 1

Primips: 18-20/40.
Multips: 16/40.

Question 2

What happens to the pattern on FM throughout the pregnancy?

Answer 2

Increases until 32/40 then plateau’s.
But there should be NO reduction in FM in 3rd trimester.

Question 3

Which structural abnormality will increase the FM perceived by the women?

Answer 3

Anencephaly

Question 4

What factors decrease FM perceived by women?

Answer 4

Sitting or standing position.
<28/40 with anterior placenta.
Foetal with major malformation.

Question 5

In what position is the foetus commonly found in women with no perception of FM despite FM being seen on USS?

Answer 5

80% are found to be lying with spine anterior.

Question 6

At what gestation should women with RFM be seen in obstetric triage?

Answer 6

From 28+0/40

Question 7

If a women is unsure about her FM, what advice should she be given?

Answer 7

Lie on left side and focus on FM for 2 hours. If <10 FM then to contact obstetric triage.

Question 8

From what gestation should CTG be carried out for RFM?

Answer 8

28/40 and use DR

Question 9

The FH accelerates with what proportion of gross movements felt by the woman?

Answer 9

92-97%

Question 10

For how long can a term foetus experience accelerations (before this becomes concerning of foetal compromise)?

Answer 10

80 mins.
(>80 mins likely sign of foetal compromise).

Question 11

What management plan should be offered to a low risk woman presenting with her first episode of RFM who is reassured after her CTG?

Answer 11

Discharge, reassure and safety net.
No US required.

Question 12

What investigations should be carried out for a women presenting with RFM <24/40?

Answer 12

Auscultate FH with Doppler (24-28/40).

If never felt movements, then refer for assessment of neuromuscular conditions.

Question 13

What proportion of women who experience a single episode of RFM continue on to have an uncomplicated pregnancy?

Answer 13

70%
Therefore, not recommended to follow up these women.

Question 14

What factors increase the risk of stillbirth?

Answer 14

FGR /SGA/ IUGR.
Placental insufficiency.
Duration of or persistent or recurrent RFM.
Congenital malformations.
HTN.
Diabetic.
Extremes of maternal age.
P0.
Smoking.
Obesity.
Poor obstetric history.
Racial, ethnic and genetic factors.