RFM

Question 1

When should foetal movements start

Answer 1

~18-20 weeks (maybe later in primips)

Question 2

When do foetal movements stop increasing?

Answer 2

34 weeks

Should be 10+ kicks in 2 hours

Question 3

When should women contact their maternity unit if they are concerned about foetal movements?

Answer 3

After 28 weeks

If unsure, lie on left side and focus for 2 hours - if they do not feel 10 movements then contact midwife or maternity unit

Question 4

Examination for RFM?

Answer 4

Foetal HR auscultation - hand held doppler (if no signficant Hx, risk factor and normal HS –> reassure)

Obsetric exam - identify SGA babies

BP and urine dipstick

Question 5

Investigations for RFM?

Answer 5

CTG - exclude foetal compromise

USS - if normal CTG but RFM - abdominal circumference, estimated foetal weight + amniotic fluid volume

Question 6

Management of RFM

Answer 6

Single episode - reassure (70% pregnancies have 1 episode) and counsel (contact maternity unit if happens again)

Recurrent RFM - review predisposing factors
USS
Consider inducing labour

Question 7

What should be done if no foetal movements are felt by 24 weeks?

Answer 7

Refer to specialist foetal medicine (could be neuromuscular disorder)