Reduced Fetal Movement

Question 1

Movements are first perceived by the mother

Answer 1

between 18 and 20 weeks of gestation

Question 2

How many women who have a still birth report a history of RFM ?

Answer 2

55%

Question 3

When do women usually start perceiving fetal movements ?

At what GA do the fetal movements plateau ?

Answer 3

18 - 20 wks
Multi - as early as 16 wks
Primi - sometimes after 20 wks

32 wks

Question 4

Fetal movements denote integrity of ?

Answer 4

CNS & Musculoskeletal system

Question 5

Highest number of movements

• which time of the day ?
• which position?

Answer 5

In the afternoon and evening

In lying down> in sitting > standing

Question 6

Fetal sleep cycle duration ?

Answer 6

20-40 minutes
In rare cases up to 90 minutes

Question 7

How can you assess fetal movements?

Answer 7

Subjective - Maternal perception
Objective - Doppler or ultrasound

Question 8

What factors affect maternal perception of fetal movements ?

Answer 8

• Inattention of the mother
• Anterior placenta in < 28 wks GA
• Anteriorly placed fetal spine
• Congenital malformations - except anencephaly where normal or excessive fetal movements
• Drugs - betamethasone, sedating drugs

Question 9

If woman concerned about RFM, when to contact maternity unit?

If unsure about RFM , what to do ?

Answer 9

Immediately, not to wait for the next day

If unsure - left lateral position for 2 hrs - atleast 10 movements to be noted in 2 hrs

Question 10

What to do if presents with RFM before 24 wks GA ?

Answer 10

Confirm viability - hand held Doppler

If no movements felt at all by 24 wks - fetal medicine referral to exclude neuromuscular conditions

Question 11

What if presents with RFM between 24 - 28 wks GA ?

Answer 11

Confirm viability - hand held Doppler

If clinical suspicion of FGR or risk factors present - consider ultrasound assessment

Question 12

What if presents after 28 wks GA ?

Answer 12

Detailed history regarding RFM with assessment for risk factors for FGR or stillbirth
Examination
Confirm viability - auscultation

If no RFM, no risk factors, viable fetus - reassure

If RFM or risk factors - CTG for atleast 20 mins to exclude fetal compromise

If CTG normal and RFM persists or risk factors - ultrasound - preferably within 24 hrs - assess AC and/or EFW and AFV

Question 13

Fetal heart rate acceleration is seen in how many gross body movements?

Answer 13

92-97%

Question 14

Fetal compromise likely - when no FHR acceleration for how many minutes ?

Answer 14

> 80 minutes

Question 15

Value of Biophysical profile in RFM patients

Answer 15

Selective role in high risk patients

Good Negative predictive value

Fetal death rare with a normal BPP

Question 16

Single episode of RFm - how many pregnancies have a normal outcome ?

Answer 16

70%

Question 17

What if recurrence of RFM ?

Answer 17

Reassess history for risk factors

Repeat ultrasound

Plan of delivery to be individualized - preferably consultant led unit