Reduced/Changed Foetal Movements

Question 1

Describe normal foetal movements

Answer 1

Start from 18-20 weeks
Quickly shows a regular patterns
Feels like a kick, flutter, swish, roll
Movements should increase in frequency until 32 weeks → plateau (av. 31 per hour)
“sleep cycles”: absent for 20-40 minutes regularly throughout day and night
There should not be any reductions in frequency in the last trimester

Question 2

What are the risk factors for reduced foetal movements

Answer 2

Foetal growth restriction
Small for gestational age (SGA) foetus
Placental insufficiency
Congenital malformation
Cigarette smoking
Corticosteroid use
Anteriorly-positioned placenta <28 weeks
Sedating drugs e.g. alcohol, benzos, methadone, opioids

Question 3

What should women be instructed to do if they are unsure if there are reduced foetal movements

Answer 3

Advise to lie on their left side and focus on foetal movements for 2 hours. If they do not feel 10 or more discrete movements in 2 hours they should contact their midwife.

Question 4

What should be looked for on examination for reduced foetal movements

Answer 4

1. Auscultate foetal heart using handheld Doppler (exclude foetal death)
2. Abdominal examination
3. SFH measurement
4. BP and urine dip
5. CTG (20 minutes, assess FHR)
6. Ultrasound biometry: AC, EFW, AFV, foetal morphology

Question 5

What is the management for reduced foetal movements

Answer 5

1. Admit to the day maternity unit
   - Assess risk (look for risk factors)
   - If it is clear that there are no RFM, and there are no other risk factors for stillbirth with the presence of a foetal heart rate on auscultation, reassure the mother
2. Provide re-assurance: 70% of pregnancies with a single episodes of RFM are uncomplicated
3. Conduct above assessments
4. May require 24hr CTG monitoring

Question 6

What is the prognosis for reduced foetal movements

Answer 6

Two or more occasions of RFM increases the risk of stillbirth, FGR, or preterm birth compared to those with only one occasion.
55% of women experiencing stillbirth perceived RFM prior to diagnosis

Question 7

Counsel on recognising foetal movements

Answer 7

There is no set number of normal movements and every pregnancy is different - usually your baby will have their own pattern of movements that you should get to know.
It is NOT TRUE that babies move less often towards the end of pregnancy. From 16-24 weeks on you should feel the baby move more and more up until 32 weeks then movements should stay roughly the same until you give birth.
Later on in pregnancy it is really important to be aware of the baby’s activity. You should CONTINUE to feel your baby move right up to the time you go into labour.
A change, especially a reduction in movements, may be a warning sign that the baby is not well and needs checking. You must NOT WAIT until the next day to seek advice if you are worried about your baby’s movements.