Decreased Fetal Movement

Pregnant pt at >24 WGA with h/o smoking and intrauterine growth restriction (IUGR) presents with perceived decreased fetal movement during. Reports laying on side and counting fewer than 10 kicks during the past two hours. Pt took sedating medications including a benzodiazepine and non-benzodiazepine hypnotic shortly before onset of decreased fetal movement. Denies vaginal bleeding/discharge, contractions. Reduced fundal height and no fetal movements palpated on exam.

• Fewer than 10 kicks in two hours: Perform non-stress test and biophysical profile within 24 hours

• Recurrent decreased fetal movement:

  • <37 weeks: Perform a non-stress test and ultrasound twice weekly

  • 37 to 39 weeks: Consider induction

  • >39 weeks: Deliver infant

• Pt counseled that

  • Fetal activity may vary throughout the day and is generally greatest in the late evening

  • Perceived movement may decrease in the third trimester as room for fetal movement decreases

    
    

Notes

• Quickening (first perceived fetal movements) may occur between 13 and 25 WGA

• Factors that may contribute to perceived decreased fetal movement

  • Decreased maternal perception of movement due to

    • Early or late gestational age

    • Maternal position, e.g. standing

    • Maternal distraction

  • Sedating medications including benzodiazepines and non-benzodiazepine hypnotics (e.g. zolpidem)

• Patients with decreased fetal movement

  • Should contact a provider if they experience no fetal movement for 2 hours

  • Are at greater risk for stillbirth; however, intervention may not change outcomes and increases c-section rates (debate exists about the evidence)

• Kick counts

  • No strong evidence that it improves outcomes

  • Should not be performed in the supine position

  • If performed, fewer than 10 kicks in 2 hours should prompt further evaluation

• Biophysical profile