Reduced Fetal Movements Flashcards
When do women start feeling foetal movements and how will they change over the pregnancy?
At 18-20 weeks (?earlier if multip) will increase up to around 32 weeks and then plateau
What can influence a woman’s ability to interpret fetal movements?
Women who are busy and on their feet will often not notice them and then will become concerned
Anterior placentas can affect a woman’s ability to feel fetal movements before 28 weeks
What drugs can lead to reduced fetal movements?
Alcohol, BZDs and opioids
When should women be made aware of fetal movements patterns and what advice should be given?
Tell women as early as possible when they can expect to feel fetal movements and how they should change over the course of their pregnancy.
They should be advised that should they ever feel worried about reduction in fetal movements they should not wait until the next day for assessment
What could some causes of RFM be?
Fetal death
Drugs and alcohol
IUGR (extreme starvation, poor oxygen supply, placental hypertrophy, cardiac disease)
Poor trophoblastic infiltration
SGA
Placental insufficiency e.g. pre-eclampsia, smoking
What is the first thing you should do if a woman presents with RFM?
Auscultate fetal heart beat - if in community then send woman to hospital
If fetal heart is present what should you assess next?
Arrange for CTG if woman is beyond 28w - this will help rule out any fetal distress. Assess for at least 20mins
Assess for evidence of growth restriction
SFH, Palpation, scans
What percentage of women with RFM go on to have complicated pregnancies?
70% women with single episode RFM will have normal pregnancy
How do we managed RFM before 24 weeks?
Confirm fetal heart beat
If never been felt before refer to specialist clinic
How do we manage RFM between 24-28 weeks?
Confirm fetal heart beat with RFM
Comprehensive still birth risk analysis
Consider delivery - experienced obstetrician decision
