Reduced Fetal Movements

Question 1

Give 2 physiological and 4 pathological causes for reduced fetal movements

Answer 1

Physiological = Fetal sleep; Busy mother; Anterior placenta

Pathological =
- Intrauterine death
- Placental insufficiency
- Placental abruption
- Congenital abnormality (eg Neurological problems)
- Polyhydramnios
- Sedating drugs

Question 2

Give 4 risk factors for fetal growth restriction

Answer 2

Previous fetal growth restriction
BMI <20
Smoking
Alcohol
Substance abuse
Placental pathology (placenta previa)
Hypertension (incl pre-eclampsia)

Question 3

How does an assessment of acute versus chronic compromise (reduced fetal movements) differ?

Answer 3

Evidence / risk of ACUTE compromise > use of CTG should help detect fetal distress

Evidence / risk of CHRONIC compromise > look for growth restriction (USS)

Question 4

How is reduced fetal movements assessed?

Answer 4

Detailed history
- Risk factors for fetal growth restriction / stillbirth (smoking, pain/bleeding, PET, diabetes, OC trauma within 48 hours, previous obs history, PMHx)
- Maternal observations, urinalysis (if mother is hypotensive etc then consider Placental abruption etc)

Is patient on scan pathway? Review growth to date.

SFH measurement, plotted on customised chart (can see if fetal growth has slowed down)

Fetal heart assessment (Auscultate if <26/40. Dawes Redman CTG if >26/40)

Question 5

What is the management for reduced fetal movements?

Answer 5

Low risk, first episode > Normal maternal assessment + Computerised CTG normal + Normal fetal movements now = reassure, home with advice, return if further concern re FM, continue routine care

Low risk and >1 episode, OR Risk factors present:
- Firstly > Normal maternal assessment? Computerised CTG normal? If those are normal then USS pathway (below…)
> Patient not on scan pathway = Arrange scan for growth + liquor plus doppler within 72 hours
> Patient on scan pathway = If normal scan within last 2 weeks and CTG/movements/assessment normal = no further Mx

If >39/40 + reduced fetal movements = offer delivery

Question 6

What are the 2 Criteria assessed on CTG?

Answer 6

One of the criteria is STV (short-term variation), which cannot be reliably assessed by human eye > It is highly correlated with outcomes when measured over a 60 minute period

Another criteria is HIGH EPISODES (cluster of accelerations around the time of movement)