Evaluation of decreased fetal movements
- Ruth C Fretts, MD, MPH
Ruth C Fretts, MD, MPH
- Assistant Professor of Obstetrics & Gynecology
- Harvard Medical School
Perception of fetal movement typically begins in the second trimester, 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 . Awareness of fetal movement is a means for the mother to monitor her fetus without the need for a clinician or equipment. Maternal perception of fetal movement is reassuring to pregnant women, whereas decreased fetal movement (DFM) is a common reason for concern.
Maternal monitoring of fetal movement is a means of screening fetal status. The rationale is based on the assumption that early recognition of decreased fetal movement (DFM) makes it possible for the clinician to intervene at a stage when the fetus is still compensated, and thus prevent progression to fetal or neonatal injury or death.
NORMAL FETAL MOVEMENT
Fetal activity can be noted sonographically as early as the first trimester and includes a wide range of movements of the 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 correlated sonographically, one study found about 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 a literature review, mothers perceived 33 to 88 percent of ultrasonographically visualized fetal movements .
The perceived frequency of fetal movement in normal pregnancy is constant throughout the third trimester , although the quality of perceived movements changes. Reports of reduced activity towards term are either based upon data from high-risk pregnancies, where reduced activity may not be normal, or due to counting during fetal quiet cycles, which become longer with advancing gestation. Fetal movement increases throughout day, with peak activity late at night .
DECREASED FETAL MOVEMENT (DFM)
We base the diagnosis of DFM upon qualitative maternal perception of a reduction of fetal movement.
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- NORMAL FETAL MOVEMENT
- DECREASED FETAL MOVEMENT (DFM)
- Patient counseling
- PREVALENCE AND SIGNIFICANCE
- Decreased maternal sensitivity to fetal movement
- Transient decreases in fetal movement
- Clinical evaluation
- Nonstress test/cardiotocography
- Additional testing
- - Ultrasound examination
- - Doppler velocimetry
- - Testing for fetomaternal transfusion
- FOLLOW-UP AND DELIVERY
- RESEARCH GAPS
- SUMMARY AND RECOMMENDATIONS