One of the indicators that the baby’s condition in utero is deteriorating is a reduction in fetal movements. Several studies have indicated that mothers routinely become aware of absent or reduced fetal movements for a few days before the baby dies. It is reason enough for health care providers to advise mothers to routinely monitor fetal movements as one of the ways to assess the status quo of their babies.
The awareness of reduced fetal movements among women diminishes if the placenta grows at the front of the uterus, in maternal obesity and cigarette smoking.
When a pregnant woman reports at the health facility with a complaint of reduced fetal movements, management plans include expedited delivery or expectant management with the baby’s condition closely monitored. We can use various tests to assess the wellbeing of the baby – Cardiotocography, fetal arousal tests, and biophysical profile.
Doppler ultrasound is invaluable in assessing blood flow, especially in the umbilical cord. Cardiotocography is the visual or computer-generated analysis of the heartbeat of the baby with uterine activity. We can do the fetal arousal tests either clinically or with cardiotocography. We use ultrasonography to assess the biophysical profile.
There’s limited evidence to support the effectiveness of monitoring fetal movements and the management plans that follow in improving the clinical outcomes. Because monitoring of fetal movements is such a highly variable parameter, there’s a potentiated risk of unnecessary interventions, preterm deliveries, and increased maternal anxiety.
Related: Antenatal Care: Increase Awareness
The scientific data to generate evidence-based management guidelines about the clinical approach to a mother who reports reduced fetal movements is scarce. Several clinical societies, associations have, however, come up with the following guidelines to use. They base them on consensus.
- On a routine basis, provide all pregnant women with verbal and written information regarding acceptable fetal movements during the antenatal period. Describe how the movement patterns change as the fetus develops, usual wake/sleep cycles, factors that may modify the mother’s perception of movements like maternal weight and placental position.
- In case of any concern about reduced or absent fetal movements, healthcare providers should advise all women to contact them immediately – not wait till the next day.
- a. After discussion, guide all women who remain unsure whether movements are reduced or not on counting fetal movements – to count while lying down on her side and concentrating on fetal movements. As a rule, when the baby is restive if fetal movements felts are less than 10 in two hours, she should contact her healthcare provider.
- b. The maternal concern of reduced fetal movements overrides any definition of reduced fetal movements based on numbers of fetal movements. Encourage women with this concern to contact their healthcare provider.
4. a. Clinicians should emphasize the importance of maternal awareness of fetal movements at every routine antenatal contact.
b. Currently, we do not recommend the use of kick-charts as part of the usual ANC.
5. When a woman presents with reduced fetal movements, assess both of them as soon as possible. Preferably, this assessment should be made within two hours if fetal movements are absent and within 12 hours if the woman reports them as reduced.
6. Assess for the presence of other risk factors associated with an increased risk of stillbirth in all women with reduced fetal movements. And if these are present, such women should be managed under the high-risk pregnancy category. These factors include fetal growth restriction, hypertension, diabetes, and advanced maternal age and others.
7. Clinical assessment of a woman with reduced fetal movements should often include a review of fetal growth – noted by symphysis-fundal height measurements in the antenatal card.
8. Whenever available, perform a cardiotocograph (CTG) to exclude fetal compromise, and if the pattern is abnormal, we recommend further evaluation.
9. If a woman persists that her fetal movements have decreased despite a normal CTG, consider a biophysical profile as part of the preliminary investigation. Do the same in the event of suspected fetal growth restriction.
10. It is needful that you assess the morphology of the fetus ultrasonographically if you did not perform it.
11. When indicated, perform an ultrasound examination due to decreased fetal movements within 24 hours.
12. When you detect a CTG abnormality, despite ultrasound features of an ideally grown fetus, consider testing for fetal-maternal haemorrhage in the preliminary investigation.
13. Individualize any further management if maternal concern remains about reduced fetal movements, despite a wonted clinical assessment including a CTG and ultrasound examination.
This article has been made possible with the help of the data published by Hofmeyr and Novikova. Read their full article here.