Makindo Medical Notes

👶 Fetal movements are a reassuring sign of fetal well-being. Most women notice them from around 18–20 weeks, with movements becoming stronger and more regular as pregnancy progresses. 🚨 A noticeable reduction or change in fetal movements may indicate potential fetal distress or complications, requiring prompt evaluation.

✅ What is Considered Normal?

• 🤰 Most women first feel movements between 18–24 weeks (earlier in multiparous women).
• 📈 By the third trimester (after 28 weeks), movements become more regular and easier to track.
• 🔄 Movements increase in frequency and strength until ~32 weeks, then plateau but should not reduce.
• 🦶 Normal movements include kicks, rolls, swishes, and turns.

⚠️ Causes of Reduced / Changed Movements

• 💤 Fetal sleep cycles: Quiet phases lasting 20–40 minutes (up to 90 minutes).
• 🩸 Placental insufficiency: Reduced oxygen/nutrient delivery to the fetus.
• 💧 Oligohydramnios: Low amniotic fluid restricting movement.
• ⛔ Fetal hypoxia/distress: Decreased activity due to impaired oxygenation.
• 👩 Maternal factors: Stress, dehydration, smoking, sedative drugs.
• 🧬 Fetal abnormalities: Congenital or chromosomal disorders may reduce activity.

🔍 Assessment of Reduced Fetal Movements

• 📖 History: Ask about frequency, pattern, and quality of movements + associated symptoms (bleeding, pain).
• 🩺 Examination: Assess maternal well-being, uterine size, and abdominal tenderness.
• 💓 Fetal heart rate monitoring: Doppler or CTG to detect abnormalities.
• 🖥️ Ultrasound: Assess growth, amniotic fluid, and placental function (consider Doppler studies).

🛠️ Management

• 🤱 Reassurance: If movements are normal after assessment, reassure and advise ongoing monitoring.
• 🧪 Further investigations: If concerns persist → growth scans, Doppler, serial CTGs.
• 👶 Early delivery: Indicated if evidence of fetal distress or severe growth restriction.
• 📊 Maternal education: Teach "count to 10" method (expect 10 movements in 2 hours after 28 weeks). Emphasise seeking help if concerned.

🚨 Red Flags (Require Urgent Action)

• ⬇️ Sudden or marked reduction in movements after 28 weeks.
• 🕛 No movements felt for >12 hours in the third trimester.
• ⚡ Movements that are weaker or markedly different in pattern.
• 🚩 Associated warning signs: vaginal bleeding, abdominal pain, fluid leakage.

👩‍⚕️ Key Considerations for Clinicians

• 🔎 Always take maternal concerns seriously—delayed action can lead to stillbirth.
• 📘 Follow NICE & RCOG guidelines on reduced fetal movements.
• 🤝 Involve multidisciplinary teams (obstetricians, midwives, fetal medicine if needed).
• 📝 Document history, examination, investigations, and advice thoroughly.