Decreased fetal movement: Diagnosis, evaluation, and management
- Ruth C Fretts, MD, MPH
Ruth C Fretts, MD, MPH
- Assistant Professor of Obstetrics & Gynecology
- Harvard Medical School
Maternal perception of fetal movement is reassuring for pregnant women, while decreased fetal movement (DFM) is a common reason for concern. While an active fetus is a reassuring sign that the fetus is alive and in good condition, the use of fetal kick counting as a fetal surveillance tool has not achieved widespread acceptance. This is, in part, because optimal methods of diagnosis, evaluation, and management of DFM have not been determined. This topic will review normal fetal movement and provide the author’s approach to diagnosis, evaluation, and management of DFM.
NORMAL FETAL MOVEMENT
Sonographically, fetal activity can be noted as early as 7 to 8 weeks of gestation . Maternal perception of fetal movement typically begins in the second trimester at around 16 to 20 weeks of gestation and occurs earlier in parous women than nulliparous women . The mother's first perception of fetal movement, termed "quickening," is often described as a gentle flutter .
In the second and third trimesters, sonography reveals a wide range of movements of the fetal trunk (eg, bending, startle, hiccup, breathing, rotation), limbs (eg, stretch, hand to face, opening and closing of hands), and face and head (eg, head rotation, suck, yawn, tongue protrusion). When sonographically detected movements were correlated with maternal perception, approximately 50 percent of isolated limb movements were perceived by the mother, whereas 80 percent of movements involving both the trunk and limb were perceived in one study . In a literature review, mothers perceived 33 to 88 percent of sonographically visualized fetal movements .
Fetal movement increases throughout day, with peak activity late at night . The frequency of fetal movement in normal pregnancy is probably constant throughout the third trimester ; however, the quality of perceived movements changes. Although some studies report that fetal activity normally decreases near term, this is likely due to counting during fetal quiet cycles, which become longer with advancing gestation, or inclusion of high-risk pregnancies.
PREVALENCE OF DECREASED FETAL MOVEMENT
At least 40 percent of pregnant women become concerned about DFM one or more times during pregnancy . Most cases are transient. Four to 15 percent of pregnant women will contact their care provider because of persistent DFM in the third trimester [8-11].
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- NORMAL FETAL MOVEMENT
- PREVALENCE OF DECREASED FETAL MOVEMENT
- PATHOPHYSIOLOGY AND SIGNIFICANCE
- DIAGNOSIS OF DECREASED FETAL MOVEMENT
- Our approach
- Kick counts
- DIFFERENTIAL DIAGNOSIS
- Initial evaluation
- Additional testing
- - Ultrasound examination
- - Doppler velocimetry
- - Testing for fetomaternal transfusion
- PREGNANCY MANAGEMENT
- SUMMARY AND RECOMMENDATIONS