Reduced Fetal Movements (RFM)

Last updated 20.09.12

 

Definition

-  Subjective perception of decreased or absent fetal movements after 24/40 pregnancy

-  At > 28/40 2hrs lying on side with focused attention on movements (kicks, flutters, swish or rolls) & <10 movements noted

 

Features

-  Approximately 36% fetal movements detected by mother

-  Fetal movements first perceived at 18 – 20/40 (as early as 16/40 for multiparous women)

-  Quickly develop regular pattern

-  Diurnal variation often afternoon & evening as peak

-  Movements plateau around 32/40

-  Absent during sleep cycle (20-40min)

-  Average 31 per hour at term

-  Increased perception when lying down

-  Decreased perception when sitting or standing

-  Movements present at later stages of pregnancy indicate fetal wellbeing & intact CNS & MSK systems

-  Decreased or absent fetal movements may be an indicator of fetal death

-  55% stillbirths report RFM prior

-  If never felt movements up to 24/40 possible CNS or MSK pathology

-  70% pregnancies single episode RFM have no complications

-  If present 2+ times ass w increased risk of poor outcome

 

Causes

-  Sedating drugs (BZDs, Opiates)

-  Corticosteroids

-  Stillbirth

-  Placental insufficiency: pre-eclampsia..

-  Sleep cycles (not >40min)

-  Major congenital malformations

-  IUGR

 

Ix

-  Dependant on gestation

-  Aim to exclude fetal death or compromise & identify those at risk

-  Abdo palp

-  Presentation

-  Size: IUGR

-  Fundal height: IUGR

-  Vitals

-  BP: exclude pre-eclampsia

-  Urine Dipstick

-  Proteinuria: >1+ consider pre-eclampsia

-  Doppler US (handheld) for all pts unless for CTG/US

-  To exclude FDIU

-  CTG

-  20min trace

-  +/- US

-  If >24/40

-  Growth (AFI, AC, EFW): IUGR

-  +/- morphology if not already completed

 

Mx

-  1st episode

-  <24/40

-   If never felt movements refer to specialist centre for ?CNS or MSK pathology

-   Doppler US for FHR

-  24/40 to 28/40

-   Doppler US for FHR

-   +/- Growth US if clinical suspician of IUGR

-  >28/40

-   If at home advise to lie on left side for 2hrs & note movements, if <10 in 2hrs for R/V

-   Doppler US for FHR

-   If nil FHR urgent US to exclude FDIU (DDx maternal pulse/trace)

-   If FHR present: 20min CTG to exclude fetal compromise

-  If abnormal Mx as per unit protocol for CTGs

-  If normal

-  Nil risk factors for stillbirth or IUGR then reassure & advise

-  If risk factors present: Growth US

-  Abnormal Mx as per unit protocol

-  Normal then reassure & advise

-  2nd episode

-  If no previous R/V: CTG +/- US

-  If Ix normal reassure & advise

-  If abnormal Mx as per unit protocol

-  Recurrent

-  Exclude risk factors

-  CTG + US

 

 

 

References

 

RCOG: Green Top Guidelines: Reduced Fetal Movements, Feb 2011