Decreased fetal movements
AFP: Decreased fetal movements- A practical approach in primary care setting
| Pregnancy factors and outcomes associated with decreased fetal movements | |
| Pregnancy factors associated with DFM | Outcomes associated with DFM |
| Fetal growth restriction Small for gestational age Placental insufficiency Oligohydramnios Threatened preterm labour Fetomaternal transfusion Intrauterine infections | Congenital malformation Preterm birth Perinatal brain injury Disturbed neurodevelopment Low birth weight Low Apgar score Hypoglycemia Cesarean section Induction of labour Fetal death Neonatal death |
- Normal fetal movements
- 10 or more fetal movements in 2 hours, felt by a woman when she is lying on her side and focusing on the movement
- 6 which may be perceived as ‘any discrete kick, flutter, swish or roll’.
- The majority of pregnant women report fetal movements by 20 weeks of gestation.
- The average number of movements perceived at term is 31 per hour, ranging from 16–45, the longest period between movements being 50–75 minutes.
- Sleep cycles, in which fetal movements can be absent, usually last 20–40 minutes and rarely exceed 90 minutes.
- As the fetus matures, the amount of movement and the nature of movement will change
- Perception of movement
- Fetal movement is a subjective measure, mainly assessed by maternal perception.
- correlation of maternal perception and ultrasound is 37–88%
- Multiple factors can decrease perception of movement
- early gestation
- reduced volume of amniotic fluid
- fetal sleep state
- obesity
- anterior placenta (up to 28 weeks gestation)
- smoking
- nulliparity
- Various drugs can cause transient suppression of fetal movement
- alcohol, benzodiazepines, methadone and other opioids, and cigarette smoking
- It is commonly thought that having a cold drink or eating something sugary will stimulate fetal movements but there is no evidence to suggest either of these will affect movement.
- Kick charts – not currently recommended, creates significant maternal anxiety and unnecessary intervention (ie induction of labour and caesarean section) have been attributed to the use of kick charts.
- If there is uncertainty surrounding perceived DFM after 28 weeks gestation, women should be advised to lie on their left side and focus on fetal movements for 2 hours. If they do not feel 10 or more discrete movements in 2 hours they should contact their healthcare provider immediately.
- Management of DFM
- will eventually need hospital referral if assessment reflects DFM
