Reduced fetal movements

What it is

The fetal kick count is the bedside measure of fetal wellbeing, and its normal is 3-5 movements/hr. It is not affected by DM. Reduced fetal movement is one of the maternal indications for doppler on the 3rd trimester scan, alongside HTN, PIH, DM, SLE, SCD and APH.

How it is diagnosed

Fetal monitoring is kick counts, non-stress tests and the biophysical profile. The biophysical profile is a non-stress test plus tone, movement, breathing, HR and AFI, and it predicts fetal wellbeing.

When the fundal height is less than the GA, the next step is to reconfirm the LMP and period of gestation, and to check fetal movement, fetal heart rate and hx of leaking; the causes to hold in mind there are wrong date, IUD, oligohydramnios, IUGR and PROM.

Where IUGR is known, antepartum fetal surveillance is the fetal kick count, a serial growth scan every 3-4 wks, and umbilical artery doppler, biophysical profile and CTG weekly.

The case this turns on is a G2P1, previous SVD, at 37 weeks, who came with reduced fetal movement and a possible hx of leaking. The scan reports a live fetus, cephalic, EFW 2 kg, AFI 5 cm, Doppler normal. Read together those three values are not normal: a weight that small at 37 weeks with an AFI of 5 cm is IUGR with oligohydramnios, and the normal Doppler tells you only that the flow is still normal.