Reduced Fetal Movement (RFM)
RCOG Guidelines Reduced Fetal Movements (Green-top Guideline No. 57) Feb 2011.
Background Information
RCOG definition: perceived fetal movements are defined as the maternal sensation of any discrete kick, flutter, swish or roll.
Most women are aware of fetal movements by 20 weeks of gestation
Advise patients that:
Women should be reassured that 70% of pregnancies with a single episode of RFM are uncomplicated.
Most women are aware of fetal movements by 20 weeks of gestation
Advise patients that:
- Fetal movement tends to plateau at 32 weeks of gestation, but there should NOT be a reduction in the frequency of fetal movement
- Fetal movement shows diurnal changes - afternoon and evening are periods of peak activity
- Fetal movements are usually absent during fetal 'sleep' cycles, which occur regularly throughout the day and night and usually last 20-40 min
Women should be reassured that 70% of pregnancies with a single episode of RFM are uncomplicated.
Guidelines
If a woman is concerned about a reduction or cessation of fetal movements after 28 weeks of gestation, she should contact her maternity unit immediately.
If unsure whether movements are reduced or not after 28 weeks:
If unsure whether movements are reduced or not after 28 weeks:
- Lie in left lateral position and focus on fetal movements for 2 hours
- If <10 discrete movements felt over 2 hours → contact maternity unit immediately
Note that the guidelines primarily focus on work-up after 28 weeks, so for <28 weeks the emphasis remains on confirming fetal viability.
The work-up depends on current gestation age:
In settings where auscultation cannot be performed, refer the woman to the maternity unit for evaluation.
The work-up depends on current gestation age:
Refer to specialist fetal medicine centre
- Detailed history
- Confirm presence of fetal heartbeat by auscultation with Doppler handheld device
In settings where auscultation cannot be performed, refer the woman to the maternity unit for evaluation.
Disclaimer: RCOG guidelines made recommendations regarding RFM in 24-28 weeks, and <24 weeks separately. However, the work-up is the same, such that the author combined them into <28 weeks.
First perform fetal heartbeat auscultation with Doppler handheld device
In settings where auscultation cannot be performed, refer the woman to the maternity unit for evaluation.
- Fetal heartbeat present → cardiotocography (CTG) for at least 20 to assess for fetal compromise
- If concerns remain despite normal CTG → in <24 hours
- Fetal heartbeat absent → immediate
In settings where auscultation cannot be performed, refer the woman to the maternity unit for evaluation.