Decreased fetal movement

Decreased fetal movements

The mother's feeling of fetal movements during pregnancy is one of the most important indicators of the fetus's health inside the womb.

Good fetal movements reflect the healthy interaction between the nervous system and the muscular/motor system in the fetus.

Any change in the nature or number of fetal movements during pregnancy may reflect the presence of a problem affecting the health of the fetus.

When does the mother begin to feel fetal movement?

Between week 18 and week 20 of pregnancy, and it may start from week 16 for some women who have previously given birth.

The number of fetal movements continues to increase until the 32nd week of pregnancy and then stabilizes.

What are the factors that reduce the mother's sense of fetal movement?

- The mother’s position, as the number of movements is more in the lying position and less in the standing position.

- The time of day, as fetal movement is felt more in the evening. This may be due to the mother being busy in the morning and unable to concentrate on the number of fetal movements.

- Location of the placenta, as the anterior placenta reduces the sensation of the number of fetal movements before 28 weeks

- Use of certain substances such as alcohol and opiates.

- Smoking, as the high percentage of carbon dioxide in the mother’s blood due to smoking leads to a decrease in the number of fetal movements.

- Fetal lung maturity injections (cortisone injections) lead to a decrease in the number of fetal movements for 48 hours after they are given.

- The presence of congenital abnormalities in the fetus.

- Neuromuscular problems in the fetus.

What is the best way to evaluate the number of fetal movements?

The best way is the mother's perception of the movements.

Are there other ways to evaluate the number of fetal movements?

Yes, such as using an ultrasound examination to count the number of movements visible during the examination.

How is fetal kick count performed correctly?

The mother should lie on her left side in a quiet room for two hours. She must count at least 10 movements within two hours.

What steps are taken when the mother complains of a decrease in the number of fetal movements?

- Taking a medical history to determine whether the mother has risk factors that affect the health of the fetus (diabetes, high blood pressure, smoking, a previous history of fetal death in the womb, etc.)

- Confirm that the number of fetal movements is low, as after speaking carefully with a number of pregnant women, it appears that the number of fetal movements is normal and there is no decrease in their number.

- Confirm whether this is the first time that the pregnant woman feels a decrease in the number of fetal movements or if there have been previous times, as repeated visits due to a decrease in the number of fetal movements may be a red flag for sudden death of the fetus inside the womb.

- Urine analysis to ensure that there is no proteinuria, as high blood pressure during pregnancy (preeclampsia) may be associated with some of these cases.

What is the next step after making sure that the number of fetal movements is really reduced?

Cardiotochography (CTG) if the gestational age is more than 28 weeks

When is the ultrasound device used to examine the fetus when the number of movements is reduced?

In one of the following cases:

- If there are risk factors in the medical history that increase the incidence of sudden death of the fetus inside the womb

- If the fetal CTG is normal, but the mother still complains of a decrease in the number of fetal movements

What parameters are recorded during the ultrasound examination in evaluating the fetus when there is a decrease in the number of its movements?

- The circumference of the fetus’s abdomen

- Estimating the weight of the fetus

- The volume of amniotic fluid around the fetus

- Blood supply to the umbilical cord

- Fetal anomaly scan to ensure that there are no congenital abnormalities

What evaluation method is used when there is a decrease in the number of fetal movements before 24 weeks or between weeks 24-28 of pregnancy?

- Listening to the fetal heartbeat (external auscultation) and making sure it is present

- Reviewing the medical history looking for possible risk factors that may affect the growth of the fetus and its health inside the womb

Pregnant women must be reassured that 70 percent of pregnant women who experience one episode of decreased fetal movements during pregnancy do not experience any subsequent complications. As for women who experience more than one episode, they must be evaluated more precisely and in-depth because they are more vulnerable to complications and intrauterine fetal death.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist