Fetal Movement

Fetal movement has been used as a non-specific indicator of fetal well-being for decades despite conflicting results of studies looking at the benefit to stillbirth rates. Reduced fetal movement is recognized as a risk factor, but management of it as a symptom is variable. Despite increasing movements being seen in healthy babies, that thinking is being modified because of recent findings that a single episode of violent or especially rigorous movement is also associated with stillbirth.

Part of the delay in accepting fetal movement awareness as a prevention opportunity is that studies could not identify a ‘normal’ or reassuring number of movements in a given time period. More recent efforts have shown that this should be replaced with advice for each mother to get to know her baby’s individual patterns and report deviations from that in quality and quantity.

Current recommendations by RANZCOG, the NHS’ Saving Babies Lives Care Bundle, and the Safer Baby Bundle encourage providers to continue educating pregnant women about monitoring fetal movement and reporting any changes. Providers should immediately evaluate all concerns with a standardized protocol. Emphasis
is placed on listening to the mothers and ensuring their concerns are addressed appropriately until they have been resolved.

Background

Decreased fetal movement is considered a possible symptom of a baby trying to conserve energy due to insufficient oxygen and nutrients. A decrease in the frequency or strength of fetal movements has been associated with an increased risk of stillbirth, which increases with recurrent episodes of altered movements. It has also been associated with low birth weight, oligohydramnios, preterm birth, congenital/chromosomal abnormalities, FMH, perinatal brain injuries, abnormal neurodevelopment, intrauterine infections, low APGAR scores, fetal acidemia, hypoglycemia, umbilical cord complications, placental insufficiency, emergent delivery, IOL, cesarean section delivery, and neonatal death. Women who have experienced stillbirth were less likely to have monitored their baby’s movements or to have been encouraged to do so by their health professionals. However, even when mothers monitor their baby’s movements, there will be no impact on outcomes if the health professionals do not respond appropriately to their concerns.

Unfortunately, many families report that they delayed contacting their health care providers about their concerns. This is often due to lack of information about the physiologic connection between fetal well-being and fetal movement, listening to myths about the baby ‘running out of room’ or drinking a cold/sugary beverage to ‘wake the baby up’, or a desire not to bother their healthcare provider. Many health professionals are uncomfortable sharing information about fetal movement with their patients because they don’t want to cause anxiety, they think the women already know this information, or they are not confident in how to respond to concerns. However, recent research provides evidence that the myths are not valid, pregnant women appreciate information about monitoring movement, and these conversations do not increase anxiety for patients.

Recommendations

• Provide all pregnant women and families verbal and written information about monitoring baby’s movements by 24 weeks, including information about why it is important
• Encourage mothers to report any deviation from the baby’s usual movement patterns immediately.
• Maternal concern of fetal movement overrides any other definition
• If a pregnant woman reports a change in fetal movement, assessment should be completed ASAP, preferably within two hours
• Evaluation for altered fetal movement should include immediate Doppler to confirm FHTs followed by clinical examination, NST, and AFI. If these tests are abnormal or the family is not reassured, consider biophysical profile, biometry, and/or testing for FMH.
• Consider delivery of women who report altered fetal movement or recurrent changes to fetal movement after 38+6 weeks gestation
• Ensure informed, shared decision-making practices are followed about timing of delivery