Introduction:
Pregnancy is an interesting journey a woman embarks on, in a bid to procreate.
This is heralded by presumptive signs in the first trimester and fetal kicks in second trimester which the mother learns to associate with a sense of well being of the developing baby inside her. Movements are first perceived by the mother between 18 and 20 weeks of gestation, which is termed “quickening,” often described as a gentle flutter and rapidly acquires a regular pattern.
Fetal movements have been defined as any discrete kick, flutter, swish or roll made by the baby. Such fetal activity provides an indication of the integrity of the central nervous and musculoskeletal systems. The normal fetus is active and capable of physical movement and goes through periods of both rest and sleep.
A significant reduction or sudden alteration in fetal movement is a potentially important clinical sign which could be a sign of impending fetal death. At least 40% of pregnant women become concerned about reduced fetal movement (RFM) one or more times during pregnancy. Most cases are transient.
When are fetal movements normal?
| The number of spontaneous movements tends to increase until the 32nd week of pregnancy then plateau. It’s important to note, there is no reduction in the frequency of fetal movements in the late third trimester. |  |
However, the type of fetal movement may change as pregnancy advances in the third trimester. By term, an average of 31 movements is felt per hour (range 16–45), with the longest period between movements ranging from 50 to 75 minutes. Fetal movements show diurnal changes. The afternoon and evening are periods of peak activity. Fetal movements are usually absent during fetal ‘sleep cycles’. These occur regularly throughout the day and night and usually last for 20–40 minutes per time. These sleep cycles rarely exceed 90 minutes in the normal healthy fetus.
Are there factors which influence a woman’s perception of this activity?
Fetal activity is influenced by a wide variety of factors. There is some evidence that women perceive most fetal movements when lying down, fewer when sitting and fewest while standing.
It is therefore not surprising that pregnant women who are busy and not concentrating on fetal activity often report a misperception of a reduction of fetal movements.
An anteriorly positioned placenta prior to 28weeks of gestation may decrease a woman’s perception of fetal movements. Sedating drugs which cross the placenta such as alcohol, benzodiazepines, methadone and other opioids can have a transient effect on fetal movements. Also cigarette smoking is associated with a decrease in fetal activity.
Fetuses with major malformations are more likely to demonstrate reduced fetal activity.
What to do when you perceive your baby isn’t moving adequately
First thing, is to lie down on your side and observe the baby’s kick for 2 hours. If you have at least 10 kicks, the baby is okay for at least 24 hours. However, if the feeling of Reduced Fetal Movement persists kindly seek medical care in a facility where you can access an obstetrician. Please don’t sleep it through the night; or postpone your visit your little one may be in danger.
References
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6. Baskett TF, Liston RM. Fetal movement monitoring: clinical application. Clin Perinatol 1989; 16:613–25.
7. Tveit JV, Saastad E, Bordahl PE, et al. The epidemiology of decreased fetal movements. Proceedings of the Norwegian Perinatal Society Conference, November 2006.
8. Frøen JF. A kick from within–fetal movement counting and the cancelled progress in antenatal care. J Perinat Med 2004; 32:13.
9. Frøen JF, Saastad E, Tveit JV, et al. [Clinical practice variation in reduced fetal movements]. Tidsskr Nor Laegeforen 2005; 125:2631.
10. Tveit JV, Saastad E, Stray-Pedersen B, et al. Reduction of late stillbirth with the introduction of fetal movement information and guidelines – a clinical quality improvement. BMC Pregnancy Childbirth 2009; 9:32.
Dr Olufolake Oni
Consultant Obstetrician
Kelina Hospital Abuja
