![]() measurement of symphysis–fundal height and palpation of abdomen, 1 which should be recorded in the pregnancy health record and compared to previous measurements 1,2,4.maternal factors such as the presence of hypertension, diabetes, smoking, extremes of age, primiparity, obesity, racial or ethnic risk factors.known intrauterine growth restriction (IUGR), placental insufficiency or congenital malformation.any fetal movements have been felt – can the DFM be attributed to being too busy to feel movements?.3 However, the following elements can be established in primary care. If a woman presents to her general practitioner with perceived DFM, she will eventually need hospital referral if assessment reflects DFM. 1 Nevertheless, maternal concern about decreased fetal movement warrants assessment even if the situation does not comply with the previously stated definition of DFM. If they do not feel 10 or more discrete movements in 2 hours they should contact their healthcare provider immediately. 3,4 If there is uncertainty surrounding perceived DFM after 28 weeks gestation, women should be advised to lie on their left side and focus on fetal movements for 2 hours. 1,2,4 In fact, significant maternal anxiety and unnecessary intervention (ie induction of labour and caesarean section) have been attributed to the use of kick charts. Kick charts, which have been historically used to monitor fetal movement, are not currently recommended. 1 It is commonly thought that having a cold drink or eating something sugary will stimulate fetal movements but there is no evidence to suggest either of these will affect movement. It is known that fewer movements are perceived when women are standing or sitting, compared with lying down or concentrating on movements. 1,2 A simple explanation provided by some women presenting with DFM is that they have been ‘too busy to feel fetal movements’. 4 Various drugs, including alcohol, benzodiazepines, methadone and other opioids, and cigarette smoking, can cause transient suppression of fetal movement. 1 Multiple factors can decrease perception of movement, including early gestation, a reduced volume of amniotic fluid, fetal sleep state, obesity, anterior placenta (up to 28 weeks gestation), smoking and nulliparity. 1–2,6 Research has shown that there is a correlation of 37–88% between maternal perception and ultrasound. 2,4 Perception of movementįetal movement is a subjective measure, mainly assessed by maternal perception. 1 Women should be educated about DFM during antenatal visits, and be given verbal and written information. 1 As the fetus matures, the amount of movement and the nature of movement will change. 1 Sleep cycles, in which fetal movements can be absent, usually last 20–40 minutes and rarely exceed 90 minutes. The average number of movements perceived at term is 31 per hour, ranging from 16–45, the longest period between movements being 50–75 minutes. 1 The majority of pregnant women report fetal movements by 20 weeks of gestation. 1 Fetal movements provide reassurance of the integrity of the central nervous and musculoskeletal systems. Normal fetal movements can be defined as 10 or more fetal movements in 2 hours, felt by a woman when she is lying on her side and focusing on the movement, 2–4,6 which may be perceived as ‘any discrete kick, flutter, swish or roll’. Pregnant women should therefore be advised to report DFM, as recognition and management may provide an opportunity to prevent adverse outcomes. Perinatal mortality rate for Aboriginal or Torres Strait Islander peoples is 20. births, and the neonatal death rate is 2. 5 In Australia, the current fetal death rate is 7. 2 Despite advances in obstetric care and decreased perinatal mortality rates in high-income countries, fetal death rates have remained stagnant for the last decade. In particular, DFM is associated with an increased risk of perinatal death (this includes fetal and neonatal deaths). ![]()
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