RFM

Question 1

First percieved?

Answer 1

18-20 weeks and rapidly acquire a pattern

Some multips may perceive FM by 16/40
Some primps may not feel FM till later on

Question 2

When does FM peak (diurnal)?

How does position of mother affect it?

Answer 2

Afternoon and evening periods

Women percieve most fetal movements when lying down, fewer when sitting and fewest and standing -> therefore busy mobile women may not feel as many kicks

Question 3

“Sleep cycle” lengths?

Answer 3

20-40 minutes -> rarely excess 90 mins in healthy fetuses

Question 4

What can reduce FM or perception of?

Answer 4

• Anteriorly positioned placenta
• Sedating drugs (such as benzodiazepines, methadone and other opiods)
• Smoking
• Major malformations
• Corticosteriods

Question 5

1. Women notices reduction in or cessation of FM after 28 weeks, what should she do?
2. Women are UNSURE if movements are reduced, what should they be advised to do?

Answer 5

1. Immediately contact maternity unit
2. Lie on their LHS and focus on FM for 2 hours. If they feel less than 10 in 2 hours they should contact the midwife or maternity unit immediately

Question 6

What should be covered in the Hx?

Answer 6

• Relevant history to assess womens Rx for stillborn and Fetal Growth restriction

History of RFM should include:

• Duration of RFM
• Absence or reduction
• How many episodes of RFM in this preg?
• Comprehensive stillbirth risk evaluation (Rx: ethnicity of African, African-Caribbean, Indian, and Pakistani, BMI >30, smoking, pre-existing diabetes, Hx of mental health problems, APH, FGR)
• Review of other factors associated with an increased risk of still birth such as:
• > multiple consultations for RFM
• > Known FGR
• > HT
• > Diabetes
• > Extremes of maternal age
• > Primip
• > Smoking
• > placental insufficiency
• > Congenital malformations
• > obesity
• > racial/ethnic factors
• > poor obs history (e.g. FGR or stillbirth)
• > Genetic factors

Question 7

What should be covered in the Clinical exam?

Answer 7

• Doppler to exclude fetal death (remember to differentiate from maternal HR) -> cant hear then refer for immediate US
• Clinical assessment for fetal size to detect SGA fetus
• > abdominal palpation
• > measurement of symphysis-fundal height
• > US biometry
• > PLUS Blood pressure +urinalysis as pre-eclam is associated with RFM

After confirmation of fetal viability and history confirms reduces FM -> CTG FOR ATLEAST 20 MINS IS OVER 28 WEEKS to exclude fetal compromise.
(So after doppler then CTG)