Reduced Foetal Movements

Question 1

What are routine tests done for smokers in pregnancy?

Answer 1

• Routine antenatal booking blood tests
• Dating USS at 13+5 +/- nuchal translucency
• Anomaly USS at 19+6
• Carbon monoxide screening - questionnaire (CO monitor pre-covid)
• Smoking cessation referral

Question 2

What is needed in a history to assess for RFM?

Answer 2

• Assessment of risk factors for stillbirth
• Previous/current FGR
• Small for gestational age fetus
• Congenital malformations
• Previous history of RFM in current pregnancy

Question 3

What is needed in an examination to assess for RFM?

Answer 3

• MEWS
• Urinalysis +/- MSSU
• Abdo exam
• Vaginal exam - if symptoms of pain or vaginal loss
• Auscultation of fetal heart with a handheld doppler

Question 4

What further investigations can be done to assess for RFM?

Answer 4

• Cardiotocogram (CTG) - used if hx confirms RFM + >26 weeks gestation, can exclude fetal compromise, has no predictive value
• USS - performed within 24 hrs if: history confirms RFM, >28+0 gestation, normal CTG, assess fetal growth, liquor volume and umbilical artery doppler

Question 5

When is the normal timeframe for a baby to start moving?

Answer 5

18-20 weeks, however, can be later in 1st pregnancy or earlier in multiparous women

Question 6

What are the types of doppler used?

Answer 6

• Uterine artery doppler: used at 23-24/40 for high risk of pre-eclampsia
• Umbilical artery doppler: used >24/40 for assessing blood supply through placenta and umbilical cord

Question 7

What is a GROW chart?

Answer 7

• FGR is associated with: stillbirth, neonatal death, perinatal morbidity
• Stillbirths due to FGR are potentially avoidable
• Fundal height should be plotted on a customised chart rather than a population-based chart as this may improve prediction of growth restriction

Question 8

What are worrying signs with baby’s movements?

Answer 8

• Change in quality or quantity
• Is this the first time it has happened
• Risk factors
• Associated: vaginal bleeding, abdo pain
• Miscarriage >24 weeks

Question 9

What is the stepwise approach to assessing RFM?

Answer 9

• Immediate auscultation of fetal heart with a handheld doppler
• That day refer to day unit for CTG
• Within 24 hrs - USS to check liquor volume + umbilical artery doppler
• In the next 1-2 weeks - USS for repeat growth +/- consultant review

Question 10

What is the management for FGR?

Answer 10

• Growth, liquor volume and doppler (umbilical) all need to be normal
• Need to consider risks with FGR e.g. is the baby still premature, what is the reduction of growth, has it stopped
• After 37 weeks the baby is no longer premature so can consider delivery if more danger for baby staying in e.g. FGR
• If liquor volume and fetal doppler both normal, then delivery can be planned for 37 wks with interim repeat liquor volume and doppler and CTG monitoring in view of FGR

Question 11

What are FGR causes?

Answer 11

• Chronic hypoxia
• Malnutrition e.g. BMI of mother <18
• Congenital abnormality e.g. heart, lung, kidneys - prevents further growth
• Placenta not receiving proper blood supply from e.g. pre-eclampsia, diabetes, autoimmune conditions