Makindo Medical Notes

Fetal movements are a sign of fetal well-being. Pregnant women typically feel fetal movements from around 18-20 weeks, with increasing frequency and strength as pregnancy progresses. A noticeable reduction or change in fetal movements may indicate potential fetal distress or underlying complications.

What is Considered Normal Fetal Movement?

• Most women will begin to feel fetal movements between 18 and 24 weeks of pregnancy.
• By the third trimester (after 28 weeks), fetal movements become more regular and easier to track.
• Fetal movements typically increase in frequency and strength up to around 32 weeks, after which they may remain steady but should not reduce in frequency.
• Normal fetal movements include kicks, rolls, swishes, and turns.

Causes of Reduced or Changed Fetal Movements

• Fetal sleep cycles: Periods of quiet lasting 20-40 minutes, or occasionally up to 90 minutes.
• Placental insufficiency: Reduced blood flow to the fetus, leading to decreased oxygen or nutrient supply.
• Oligohydramnios: Low amniotic fluid levels restricting fetal movement.
• Fetal hypoxia or distress: Reduced oxygen supply to the fetus may lead to reduced activity.
• Maternal factors: Stress, dehydration, smoking, or medication use (e.g., sedatives) can decrease fetal movements.
• Fetal abnormalities: Congenital or chromosomal conditions may affect movement.

Assessment of Reduced Fetal Movements

• History: Ask about the pattern, frequency, and type of fetal movements, along with any other symptoms (e.g., bleeding, pain).
• Physical examination: Assess maternal well-being, uterine size, and any abdominal tenderness.
• Fetal heart rate monitoring: Use a Doppler or cardiotocography (CTG) to check for fetal heart rate abnormalities.
• Ultrasound scan: Perform an ultrasound to assess fetal growth, amniotic fluid levels, and placental function (including Doppler studies if indicated).

Management

• Reassurance: If fetal movements are normal after assessment and there are no other concerns, reassure the mother and advise her to continue monitoring movements.
• Further investigations: If movements remain reduced or abnormal, perform further assessments, such as growth scans, Doppler studies, and CTG monitoring.
• Early delivery: If fetal distress or growth restriction is detected, early delivery may be recommended to ensure the baby’s safety.
• Maternal education: Educate the mother on tracking fetal movements, typically using the "count to 10" method (expecting 10 movements in 2 hours). Advise her to seek medical attention if movements decrease.

Red Flags for Immediate Medical Attention

• Sudden or significant reduction in fetal movements after 28 weeks
• No movements felt for more than 12 hours in the third trimester
• Fetal movements that have decreased in strength or pattern
• Associated symptoms such as vaginal bleeding, abdominal pain, or leakage of amniotic fluid

Key Considerations for Healthcare Professionals

• Always take maternal concerns about reduced or changed fetal movements seriously and investigate promptly.
• Ensure that women are educated about normal fetal movements and when to seek medical advice.
• Follow national guidelines (e.g., NICE, RCOG) for the management of reduced fetal movements and involve a multidisciplinary team as needed.
• Document findings and actions thoroughly in the patient’s records.