Reduced Fetal Movement (RFM)
RCOG Reduced Fetal Movements (Green-top Guideline No. 57) Feb 2011.
Background Information
Normal Fetal Movements
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
When to Seek Help
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
Simplified Flow Chart – RFM Investigation
Investigation and Work-Up
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:
Fetal Movements Never Felt <24 Weeks Gestation
Refer to specialist fetal medicine centre
RFM in <28 Weeks Gestation
- Detailed history
- Confirm the presence of fetal heartbeat by auscultation with handheld Doppler device
In settings where auscultation cannot be performed, refer the woman to the maternity unit for evaluation.
CTG is NOT recommended before 28 weeks of gestation, due to an immature fetal autonomic nervous system. There won’t be reliable accelerations or variability on the CTG.
RFM in >28 Weeks Gestation
First, perform fetal heartbeat auscultation with handheld Doppler device
- Fetal heartbeat present → cardiotocography (CTG) for at least 20 min 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.