Reduced Fetal Movement

MANAGEMENT OF DECREASED FOETAL MOVEMENTS ( > 28WKS)

DR JUDITH KUNDODYIWA MRCOG / DR FUNMI ODUSOGA

Table of content

1. Introduction

2. Initial assessment

3. Management

4. Reference

INTRODUCTION

• Decreased foetal movement (DFM) is a common occurrence which frequently is not associated with foetal pathology.
• Most pregnant women are aware of fetal movement between 16-20weeks gestation
• Women should be advised of the need to be aware of fetal movements up to and including the onset of labour and should report any decrease or cessation of fetal movements to their maternity unit
• A significant reduction or sudden alteration in fetal movement is a potential important clinical sign
• The majority of women (55%) experiencing a still birth perceived a reduction in fetal movement prior to diagnosis
• The actual number of movements increases with gestation until 32 weeks after which the number plateaus until the onset of labour
• Type of fetal movement may change as pregnancy advances in third trimester
• Fetal movements are usually absent during fetal sleep cycle which occur regularly throughout the day and night and lasts 20-40minutes. Sleep cycle rarely exceeds 90minutes in the normal healthy fetus
• Perception of reduced movements is subjective. Any change from previous movement that concerns the mother should be taken seriously
• Approximately 20% (1in 5) women presenting with DFM have small-for-gestational-age baby.
• CESDI report has shown 16% of stillbirths presented as DFM.
• Intrauterine death is preceded by cessation of foetal movement by ≥ 24 hours. Approximately 50% of women report DFM in the days before intrauterine foetal demise.

INITIAL ASSESSMENT

• Obtain a general history.
• Examination – in particular check fundal height.
• If <27wks – check foetal heart with sonicaid.
• If ≥27wks – perform CTG.
• If 2^nd episode of reduced FMs, organise scan for growth & liquor volume following by review by an obstetrician.
• If clinical suspicion of fetus being small for gestational age when fundal height plotted on customised growth chart – arrange USS for growth & liquor volume.

MANAGEMENT

• Women should not wait until the next day for assessment if they are concerned about decreased fetal movements
•  If unsure whether movements are reduced after 28 weeks of gestation, they should be advised to lie on their left side and focus on movements for 2 hours. If they do no feel 10 or more discreet movements in 2 hours, they should contact their maternity unit immediately
• If all assessments are normal, woman should see community midwife in 1 week for full antenatal check then continue antenatal care as planned.
• Encourage re-referral if problem recurs or persists.
• If small for gestational age confirmed on Ultrasound – follow SGA guideline.
• If CTG or scan abnormal, contact specialist registrar or on call/Consultant as immediate delivery may be necessary

Reference