High risk pregnancy: Decreased fetal movements

Question 1

when are fetal movements first perceived by the mother

Answer 1

Movements are first perceived by the mother between 18 and 20 weeks of gestation
• Fetal movements have been defined as any discrete kick, flutter, swish or roll.
• A significant reduction or sudden alteration in fetal movement is a potentially important clinical sign.

Question 2

Why are fetal movements important?

Answer 2

• fetal activity provides an indication of the integrity of the central nervous and musculoskeletal systems.

Question 3

Factors affecting fetal movements

Answer 3

• Anterior placenta
• Position of mother –less while standing, more on lying down
• Sedating drugs which cross the placenta such as alcohol, benzodiazepines, methadone and other opioids can have a transient effect on fetal movements.
• Fetal anomalies

Question 4

Reduced FM - when should women contact maternity unit?

Answer 4

• Women should be advised to be aware of their baby’s individual pattern of movements.
• If they are concerned about a reduction in or cessation of fetal movements after 28+0 weeks of gestation, they should
• contact their maternity unit.
• With one episode of reduced FM – no complications
• Recurrent episodes of reduced FM- exclude IUGR by ultrasound • <24 weeks- auscultate and reassure
• 24-28weeks- auscultate and reassure

Question 5

What differentials should be considered in a women presenting with reduced fetal movements?

Answer 5

• All clinicians should be aware of the potential association of decreased fetal movements with key risk factors such as FGR, small-for-gestational-age (SGA) fetus, placental insufficiency and congenital malformations.
• Exclude risk factors- smoking/IUGR/PET/HT/GDM/previous still birth/congenital anomalies
• Detailed history and examination to exclude IUGR

Question 6

Investigations for reduced fetal movements?

Answer 6

• Auscultate with doppler and listen to FHS
• The presence of a normal fetal heart rate pattern (i.e. showing accelerations of fetal heart rate coinciding with fetal movements) is indicative of a healthy fetus with a properly functioning autonomic nervous system.
• Ultrasound- growth and Amniotic Fluid Index
• 10 movement sin 2 hrs –is reassuring