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:
  • 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:
  • 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:

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
  • Fetal heartbeat present → cardiotocography (CTG) for at least 20 to assess for fetal compromise
    • If concerns remain despite normal CTG →  ultrasound scan assessment in <24 hours
 
  • Fetal heartbeat absent → immediate  ultrasound scan assessment

In settings where auscultation cannot be performed, refer the woman to the maternity unit for evaluation.

References

Author: Adams Lau
Reviewer: 
Last Edited: 28/02/25