Evaluation of decreased fetal movements

Evaluation of decreased fetal movements

Author
Ruth C Fretts, MD, MPH
Section Editor
Charles J Lockwood, MD
Deputy Editor
Vanessa A Barss, MD
Disclosures
All topics are updated as new evidence becomes available and our peer review process is
complete.
Literature review current through: Oct 2012. | This topic last updated: Nov 8, 2012.
INTRODUCTION Perception of fetal movement typically begins in the second trimester, and
occurs earlier in parous women than nulliparous women [1]. The mother's first perception of
fetal movement is termed "quickening." 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 [2]. In a literature
review, mothers perceived 33 to 88 percent of ultrasonographically visualized fetal movements
[3].
The perceived frequency of fetal movement during fetal wakefulness 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
or due to counting at specific hours, and thus biased toward fetal quiet cycles, which become
longer with advancing gestation [4]. Fetal movement increases throughout day, with peak
activity late at night [5].
DECREASED FETAL MOVEMENT (DFM) We base the diagnosis of DFM upon qualitative
maternal perception of a reduction of fetal movement.