RCOG release: Reduced fetal movements – New Green-top Guideline

New advice for clinicians on the management of women with reduced fetal movements (RFM) during pregnancy has been published by the Royal College of Obstetricians and Gynaecologists (RCOG) today.

This is the first edition of this guideline and looks at how women should be aware of their baby’s movement patterns in the womb. It also gives advice to clinicians and reviews the risk factors and factors influencing maternal perception.

Fetal movements can be anything from a kick, flutter, swish or roll and movements are typically first felt by the mother between 18-20 weeks of gestation and rapidly acquire a regular pattern. Fetal activity provides an indication of the integrity of the central nervous system and musculoskeletal systems.

A significant reduction or sudden change in movement is an important clinical sign. Reduced fetal movements usually does not indicate a problem with the pregnancy but can sometimes be an important warning sign that the fetus is not receiving enough oxygen from the mother, via the placenta.

Fetal activity is influenced by a wide variety of factors and movements are most commonly assessed by maternal perception. There is some evidence that women perceive most movement when lying down, fewer when sitting and least while standing. Busy pregnant women for example who are not concentrating on fetal activity often report a misperception of a reduction of fetal movement.

The guideline states that if a woman is worried about her unborn baby’s movements she should contact her maternity unit.  However, clinicians should be aware that instructing women to monitor fetal movements is potentially associated with increased maternal anxiety.

After 28 weeks of gestation if a woman is unsure whether movements are reduced she is advised to lie on her left side and focus on fetal movement for 2 hours. If she does not feel 10 or more discrete movements then she should contact her midwife or maternity unit immediately. 

If a clinician is presented with a woman reporting RFM, a relevant history should be taken to assess the woman’s risk factors for stillbirth and fetal growth restriction (FGR).

In most cases a handheld Doppler device can be used to confirm the presence of the fetal heart beat. If the presence of a fetal beat is not confirmed then immediate referral for an ultrasound scan is needed to assess fetal cardiac activity.

Cardiotocographic (CTG) monitoring of the fetal heart rate should be used if the pregnancy is over 28 weeks of gestation and there is still a decrease in fetal movements after fetal viability has been confirmed. CTG monitoring for at least 20 minutes can provide an easily accessible means of detecting any problems.

Ultrasound scanning can also be used as part of the preliminary investigations of a woman reporting RFM if the perception of RFM persists despite a normal CTG.

However, the guideline states that women should be reassured that 70% of pregnancies with a single episode of RFM are uncomplicated. Women who report RFM on two or more occasions are at an increased risk of a poorer perinatal outcome including an increased risk of stillbirth, fetal growth restriction and/or preterm birth.

Dr Melissa Whitworth, Consultant Obstetrician, St Mary’s Hospital, Manchester and lead author of the guideline said:

“Being aware of babies’ movements is something that Mums can do to monitor the health of their unborn child. A reduction in movements can mean that the baby is not well in the womb and a very small proportion of these babies need to be delivered urgently. This guideline will hopefully help clinicians to provide high quality care for women with reduced fetal movements.”

The President of the RCOG, Dr Tony Falconer said:

“Maternal perception of fetal movement is one of the first signs of fetal life and is an exciting time for the mother. Understandably, mothers may feel anxious if there is a decrease in fetal movement however there are often plausible reasons for this.

“The fetus may be in a state of sleep or the mother may be too busy to focus on fetal activity. It is important to remember however that each case is different and this new guideline is an extremely useful resource for clinicians treating women who may encounter reduced fetal movements.”


For more information please contact Naomi Weston on 020 7772 6357 or nweston@rcog.org.uk


To read the full guideline please click here.

Date published: 25/02/2011
Published by: Naomi Weston
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