Recommendations for fetal movement monitornig and assesment
Reduced fetal movements or change in pattern of fetal movements may be associated with poor perinatal outcome. In case of reduced fetal movements inadequate response of physician -gynecologist and obstetrician is a factor that contributes to stillbirth. All pregnant women should be given information about the normal fetal movement. We recommend uniform informing about fetal movements monitoring, a uniform method of monitoring fetal movements (modified "count to ten" method) and using a uniform table/chart for recording fetal movements. In case of maternal perception of less than ten movements within 2 hours, women should contact their maternity unit. Appointment is also necessary in case of changes in the pattern of fetal movements or sudden significant prolongation of time to count 10 moves that persist over several days. The history and clinical examination help us find high risk pregnancies. At every appointment we should monitor blood pressure and test urine for proteinuria. Clinical assessment of women with reduced fetal movements should include assessment of fetal size with the aim of detecting fetuses small for gestational age. CTG is needed to exclude fetal compromise if the pregnancy is over 28 weeks of gestation. Ultrasound scan assessment should be done if there are any additional risk factors for stillbirth, in case of pathological CTG and if the perception of reduced fetal movements persists despite a normal CTG.
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