Recommendations for fetal movement monitornig and assesment

  • Vid Janša Department of Perinatology, Division of Gynaecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
  • Gabrijela Bržan Šimenc Department of Perinatology, Division of Gynaecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
  • Tanja Premru Sršen Department of Perinatology, Division of Gynaecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
Keywords: antenatal care, fetal movement, fetal movement counting, reduced fetal movements, stillbirth



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.


Download data is not yet available.


Malm L, Radestad I. 2011 Losing contact with one’s unborn baby—mothers’ experiences prior to receiving news that their baby has died in Utero. Omega (Westport) 2010–2011; 62 (4): 353– 67.

Royal College of Obstetricians and Gynaecologists (RCOG). Reduced Fetal Movements. Green-top Guideline No. 57. 2011 Feb. 16 p. Retrieved December 2014.

Valentin L, Marsal K. Pregnancy outcome in women perceiving decreased fetal movement. Eur J Obstet Gynecol Reprod Biol 1987;24: 23- 32.

Whitty JE, Garfinkel DA, Divon MY. Maternal perception of decreased fetal movement as an indication for antepartum testing in a low-risk population. Am J Obstet Gynecol 1991 ;165: 1084- 8.

Bekedam DJ, Visser GH. Effects of hypoxemic events on breathing, body movements, and heart rate variation: a study in growth-retarded human fetuses. Am J Obstet Gynecol 1985; 153: 52- 6.

Gagnon R, Hunse C, Fellows F, Carmichael L, Patrick J. Fetal heart rate and activity patterns in growth-retarded fetuses: changes after vibratory acoustic stimulation. Am J Obstet Gynecol 1988; 158: 265- 71.

Ribbert LS, Nicolaides KH, Visser GH. Prediction of fetal acidaemia in intrauterine growth retardation: comparison of quantified fetal activity with biophysical profile score. Br J Obstet Gynaecol 1993; 100: 653- 6.

Sival DA, Visser GH, Prechtl HF. The effect of intrauterine growth retardation on the quality of general movements in the human fetus. Early Hum Dev 1992; 28: 119- 32.

Vindla S, James DK, Sahota DS, Coppens M. Computerised analysis of behaviour in normal and growth-retarded fetuses. Eur J Obstet Gynecol Reprod Biol 1997; 75: 169- 75.

Vindla S, James D, Sahota D. Computerised analysis of unstimulated and stimulated behaviour in fetuses with intrauterine growth restriction. Eur J Obstet Gynecol Reprod Biol 1999; 83: 37- 45.

Sherer DM, Spong CY, Minior VK, Salafia CM. Decreased amniotic fluid volume at < 32 weeks of gestation is associated with decreased fetal movements. Am J Perinatol 1996; 13: 479- 82.

Lin CC, Adamczyk CJ, Sheikh Z, Mittendorf R. Fetal congenital malformations. Biophysical profile evaluation. J Reprod Med 1998; 43: 521- 7.

Naeye RL, Lin HM. Determination of the timing of fetal brain damage from hypoxemia-ischemia. Am J Obstet Gynecol 2001; 184: 217- 24.

James DK, Telfer FM, Keating NA, Blair ME, Wilcox MA, Chilvers C. Reduced fetal movements and maternal medication - new pregnancy risk factors for neurodevelopmental disability in childhood. J Obstet Gynaecol 2000; 20: 226- 34.

Goldstein I, Romero R, Merrill S, Wan M, O'Connor TZ, Mazor M, Hobbins JC. Fetal body and breathing movements as predictors of intraamniotic infection in preterm premature rupture of membranes. Am J Obstet Gynecol 1988; 159: 363- 8.

Sadovsky E, Yaffe H. Daily fetal movement recording and fetal prognosis. Obstet Gynecol 1973; 41: 845- 50.

Tveit JV, Saastad E, Bordahl PE, Stray-Pedersen B, Frøen JF. The epidemiology of decreased fetal movements. In: Annual conference of the Norwegian Perinatal Society; 2006; Oslo, Norway; 2006.

Rayburn WF, McKean HE. Maternal perception of fetal movement and perinatal outcome. Obstet Gynecol 1980; 56: 161- 4.

Fischer S, Fullerton JT, Trezise L. Fetal movement and fetal outcome in a low-risk population. J Nurse Midwifery 1981; 26: 24- 30.

Frøen JF. A kick from within-fetal movement counting and the cancelled progress in antenatal care. J Perinat Med 2004; 32: 13- 24.

Sinha D, Sharma A, Nallaswamy V, Jayagopal N, Bhatti N. Obstetric outcome in women complaining of reduced fetal movements. J Obstet Gynaecol 2007; 27: 41- 3.

Grant A, Elbourne D, Valentin L, Alexander S.Routine formal fetal movement counting and risk of antepartum late death in normally formed singletons.Lancet 1989; 2(8659): 345- 9.

Harrington K, Thompson O, Jordan L, Page J, Carpenter RG, Campbell S. Obstetric outcome in women who present with a reduction in fetal movements in the third trimester of pregnancy.J Perinat Med 1998; 26(2): 77- 82.

Johnson TR, Jordan ET, Paine LL. Doppler recordings of fetal movement: II. Comparison with maternal perception. Obstet Gynecol 1990 ; 76(1): 42- 3.

Tuffnell DJ, Cartmill RS, Lilford RJ. Fetal movements; factors affecting their perception. Eur J Obstet Gynecol Reprod Biol. 1991; 39(3): 165- 7.

Hijazi ZR, East CE. Factors affecting maternal perception of fetal movement. Obstet Gynecol Surv 2009; 64(7): 489- 97.

Frøen JF, Saastad E, Tveit JV, Børdahl PE, Stray-Pedersen B. Clinical practice variation in reduced fetal movements. Tidsskr Nor Laegeforen 2005; 125: 2631– 4.

Sergent F, Lefevre A, Verspyck E, Marpeau L. Decreased fetal movements in the third trimester: what to do? Gynecol Obstet Fertil 2005; 33: 861- 9.

Tveit JV, Saastad E, Stray-Pedersen B, Børdahl PE, Flenady V, Fretts R, Frøen JF. Reduction of late stillbirth with the introduction of fetal movement information and guidelines – a clinical quality improvement. BMC Pregnancy Childbirth 2009; 9: 32.

Efkarpidis S , Alexopoulos E, Kean L, Liu D, Fay T. Case-control study of factors associated with intrauterine fetal deaths. MedGenMed. 2004; 6(2): 53.

Fossen D, Silberg IE. Perinatal deaths in the county of Ostfold 1989-97. Tidsskr Nor Laegeforen 1999; 119(9): 1272- 5.

Saastad E, Vangen S, Frøen JF. Suboptimal care in stillbirths - a retrospective audit study. Acta Obstet Gynecol Scand 2007; 86(4): 444- 50.

Australian and New Zealand Stillbirth Association. Clinical Practice Guideline for the Management of Women who report Decreased Fetal Movements. First edition, Version 1.1. 2010 Jul. Retrieved June 2013.

Liston RM, Sawchuck D, Young DC. fetal health surveillance: antepartum and intrapartum consensus guideline. SOGC Clinical Practice Guideline No. 197, September 2007. J Obstet Gynaecol Can 2007; 29: (suppl).

Neldam S. Fetal movements as an indicator of fetal well-being. Dan Med Bull 1983; 30 (4): 274- 8.

Marsál K. Ultrasonic assessment of fetal activity. Clin Obstet Gynaecol 1983; 10 (3): 541- 63.

D'Elia A, Pighetti M, Moccia G, Santangelo N. Spontaneous motor activity in normal fetuses. Early Hum Dev 2001; 65 (2): 139- 47.

Natale R, Nasello-Paterson C, Turliuk R. Longitudinal measurements of fetal breathing, body movements, heart rate, and heart rate accelerations and decelerations at 24 to 32 weeks of gestation. Am J Obstet Gynecol 1985; 151: 256– 63.

Eller DP, Stramm SL, Newman RB. The effect of maternal intravenous glucose administration on fetal activity. Am J Obstet Gynecol 1992; 167: 1071– 4.

Cito G , Luisi S, Mezzesimi A, Cavicchioli C, Calonaci G, Petraglia F. Maternal position during non-stress test and fetal heart rate patterns. Acta Obstet Gynecol Scand 2005; 84 (4): 335- 8.

Patrick J, Fetherston W, Vick H, Voegelin R. Human fetal breathing movements and gross fetal body movements at weeks 34 to 35 of gestation. Am J Obstet Gynecol. 1978; 130 (6):693- 9.

Minors DS, Waterhouse JM. The effect of maternal posture, meals and time of day on fetal movements. Br J Obstet Gynaecol 1979; 86 (9): 717- 23.

Patrick J, Campbell K, Carmichael L, Natale R, Richardson B. Patterns of gross fetal body movements over 24-hour observation intervals during the last 10 weeks of pregnancy. Am J Obstet Gynecol 1982; 142 (4): 363- 71.

Moore TR, Piacquadio K. A prospective evaluation of fetal movement screening to reduce the incidence of antepartum fetal death. Am J Obstet Gynecol 1989; 160 (5): 1075- 80.

Velazquez MD, Rayburn WF. Antenatal evaluation of the fetus using fetal movement monitoring. Clin Obstet Gynecol 2002; 45 (4): 993- 1004.

Neldam S, Jessen P. Fetal movements registered by the pregnant woman correlated to retrospective estimations of fetal movements from cardiotocographic tracings.Am J Obstet Gynecol 1980; 136: 1051– 4.

Richardson BS,O’Grady JP,Olsen GD. Fetal breathing movements and the response to carbon dioxide in patients on methadone maintenance. Am J Obstet Gynecol 1984; 150: 400– 5.

Castillo RA,Devoe LD,Ruedrich DA,Gardner P.The effects of acute alcohol intoxication on biophysical activities: a case report.Am J Obstet Gynecol 1989; 160: 692– 3.

Robertson SS,Dierker LJ. Fetal cyclic motor activity in diabetic pregnancies: sensitivity to maternal blood glucose. Dev Psychobiol 2003; 42: 9– 16.

Zisser H, Jovanovic L, Thorsell A, Kupperman A, Taylor LJ, Ospina P, Hod M. The fidgety fetus hypothesis: fetal activity is an additional variable in determining birth weight of offspring of women with diabetes. Diabetes Care 2006; 29: 63– 7.

Birkenfeld A, Laufer N, Sadovsky E. Diurnal variation of fetal activity. Obstet Gynecol 1980; 55: 417- 9.

Manning F, Wyn Pugh E, Boddy K. Effect of cigarette smoking on fetal breathing movements in normal pregnancies. Br Med J 1975; 1: 552– 3.

Ritchie K.The fetal response to changes in the composition of maternal inspired air in human pregnancy. Semin Perinatol 1980; 4: 295– 9.

Magee LA,Dawes GS,Moulden M,Redman CW. A randomised controlled comparison of betamethasone withdexamethasone: effects on the antenatal fetal heart rate.Br J Obstet Gynaecol 1997; 104: 1233– 8.

Mulder EJ,Derks JB,Visser GH.Antenatal corticosteroid therapy and fetal behaviour: a randomised study of the effects of betamethasone and dexamethasone.Br J Obstet Gynaecol 1997; 104: 1239– 47.

Jackson JR,Kleeman S,Doerzbacher M, Lambers DS.The effect of glucocorticosteroid administration on fetal movements and biophysical profile scores in normal pregnancies. J Matern Fetal Neonatal Med 2003; 13: 50– 3.

Kean LH, Suwanrath C,Gargari SS, Sahota DS, James DK.A comparison of fetal behaviour in breech and cephalic presentations at term.Br J Obstet Gynaecol 1999; 106: 1209– 13.

Fisher ML.Reduced fetal movements: a research-based project.Br J Midwifery 1999; 7: 733– 7.

Gettinger A,Roberts AB,Campbell S.Comparison between subjective and ultrasound assessments of fetal movement. Br Med J 1978; 2: 88– 90.

Hertogs K,Roberts AB,Cooper D,Griffin DR,Campbell S. Maternal perception of fetal motor activity. Br Med J 1979; 2: 1183– 5.

Neldam S. Fetal movements as an indicator of fetal wellbeing. Lancet 1980; 315: 1222– 4.

Rayburn WF.Clinical significance of perceptible fetal motion. Am J Obstet Gynecol 1980; 138: 210– 2.

Sorokin Y, Pillay S,Dierker LJ,Hertz RH,Rosen MG.A comparison between maternal, tocodynamometric, and realtime ultrasonographic assessments of fetal movement. Am J Obstet Gynecol 1981; 140: 456– 60.

Schmidt W,Cseh I,Hara K,Kubli F.Maternal perception of fetal movements and real-time ultrasound findings. J Perinat Med 1984; 12: 313– 8.

Valentin L,Marsál K, Lindström K.Recording of foetal movements: a comparison of three methods. J Med Eng Technol 1986; 10: 239– 47.

Besinger RE, JohnsonTR.Doppler recording of fetal movement: clinical correlation with real-time ultrasound. Obstet Gynecol 1989; 74: 277– 80.

Lowery CL, Russell WA Jr, Baggot PJ, Wilson JD, Walls RC, Bentz LS, Murphy P. Time quantified detection of fetal movements using a new fetal movement algorithm.Am J Perinatol 1997; 14: 7– 12.

Melendez TD,RayburnWF, Smith CV. Characterization of fetal body movement recorded by the Hewlett-Packard M-1350-A fetal monitor. Am J Obstet Gynecol 1992; 167: 700– 2.

ACOG. Guidelines for perinatal care. Washington DC: The American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Paediatrics.; 2002.

Mangesi L, Hofmeyr GJ, Smith V, Smyth RM. Fetal movement counting for assessment of fetal wellbeing. Cochrane Database Syst Rev 2015; 10: CD004909.

Saastad E, Tveit JVH, Flenady V, Stray-Pedersen B, Fretts RC, Børdahl PE, Frøen JF. Implementation of uniform information on fetal movement in a Norwegian population reduces delayed reporting of decreased fetal movement and stillbirth in primiparous women—A clinical quality improvement. BMC Res Notes 2010; 3: 2.

Saastad E, Israel P, Ahlborg T, Gunnes N, Frøen JF. Fetal movement counting— Effects on maternal–fetal attachment: A multicenter randomized controlled trial. Birth 2011; 38 (4): 282– 94.

Olesen AG, Svare JA. Decreased fetal movements: background, assessment, and clinical management. Acta Obstet Gynecol Scand 2004; 83: 818– 26.

Heazell AE, Sumathi GM, Bhatti NR. What investigation is appropriate following maternal perception of reduced fetal movements? J Obstet Gynaecol 2005; 25: 648– 50.

Flenady V, MacPhail J, Gardener G, Chadha Y, Mahomed K, Heazell A, Fretts R, Frøen F. Detection and management of decreased fetal movements in Australia and New Zealand: a survey of obstetric practice. Aust N Z J Obstet Gynaecol 2009; 49 (4): 358- 63.

Heazell AE, Green M, Wright C, Flenady V, Frøen JF. Midwives' and obstetricians' knowledge and management of women presenting with decreased fetal movements. Acta Obstet Gynecol Scand 2008; 87 (3): 331- 9.

Saastad E, Winje BA, Israel P, Frøen JF. Fetal movement counting--maternal concern and experiences: a multicenter, randomized, controlled trial. Birth 2012; 39 (1): 10- 20.

Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI). 8th Annual Report. London:Maternal and Child Health Research Consortium; 2001.

Royal College of Obstetricians and Gynaecologists.Greentop Guideline No. 31: The Investigation and Management of the Small-for-gestational-age Fetus. London:RCOG; 2002.

Keegan KA, Jr., Paul RH. Antepartum fetal heart rate testing. IV. The nonstress test as a primary approach. Am J Obstet Gynecol 1980; 136: 75- 80.

Malcus P. Antenatal fetal surveillance. Curr Opin Obstet Gynecol 2004; 16: 123- 8.

Freeman RK,Anderson G,DorchesterW.A prospective multiinstitutional study of antepartum fetal heart rate monitoring. I.Risk of perinatal mortality and morbidity according to antepartum fetal heart rate test results. Am J Obstet Gynecol 1982; 143: 771– 7.

O’Sullivan O, Stephen G,Martindale E,Heazell AE. Predicting poor perinatal outcome in women who present with decreased fetal movements. J Obstet Gynaecol 2009; 29: 705– 10.

How to Cite
Janša V, Bržan Šimenc G, Premru Sršen T. Recommendations for fetal movement monitornig and assesment. TEST ZdravVestn [Internet]. 28Oct.2019 [cited 26Feb.2020];88(9-10):479-0. Available from:
Professional Article