Advise women to report any decrease or cessation of fetal movements to their maternity provider. [Grade B]
There is insufficient evidence to recommend formal fetal movement counting using specified numbers. [Grade A]
All clinicians should be aware of the association of reduced fetal movements (RFM) with fetal growth restriction (FGR), a small-for-gestational-age (SGA) fetus, placental insufficiency and congenital anomalies. [Grade C]
When a woman presents with RFM in the community or hospital setting an attempt should be made to auscultate the fetal heart using a handheld Doppler device to exclude fetal death. [Grade C]
Clinical assessment of a woman with RFM should include assessment of fetal size by measuring symphysis-fundal height (if not having serial growth scans), blood pressure and urinalysis. [Grade C]
In women with RFM, after fetal viability has been confirmed, arrangements should be made for a woman to have a computerised cardiotocograph (CTG) to exclude acute fetal compromise if the pregnancy is 26+0 weeks of gestation or later (see Section 14 for recommendations prior to this gestation). [Grade B]
Ultrasound scan (USS) assessment should be undertaken as a part of the preliminary investigations of a woman presenting with RFM after 28+0 weeks of gestation if the perception of RFM persists despite a normal CTG, if there are any additional risk factors for FGR and/or stillbirth and if an USS has not been performed in the preceding two weeks. [Grade B]
If anomalies are present on antenatal CTG, intervention should be discussed with a senior obstetrician and decisions about birth should consider gestation and the degree of anomaly. [Good Practice Point (GPP)]
If the fetus is found to be SGA and/or there are anomalies of umbilical artery Doppler or liquor volume, care should be in accordance with RCOG Green-Top guideline No 31 Investigation and care of a Small for Gestational Age Fetus and a Growth Restricted Fetus. [GPP]
If women who have normal investigations after one presentation with RFM have another episode of RFM, they should be advised to contact their maternity unit for further assessment as indicated in Section 8 of this guideline. [Grade B]
Where there is no objective evidence of fetal compromise (no CTG anomalies, no evidence of reduced fetal growth, oligohydramnios or umbilical artery Doppler anomalies) women should be reassured there is no indication for expediting birth. [Grade A]
A decision to expedite birth should be made on an individual basis in partnership with the woman. If women present with RFM after 39+0 weeks of gestation, expediting birth does not appear to be associated with increased risk to the woman or baby. [Grade A]
When a woman recurrently perceives RFM her case should be reviewed to exclude predisposing causes. [Grade C]
When a woman presents with RFM in a multiple pregnancy, investigations to identify developing fetal compromise should be undertaken including CTG, assessment of fetal growth, liquor volume and umbilical artery Doppler. [Grade C]
If a woman presents with RFM between 24+0 weeks of gestation and 28+0 weeks of gestation the presence of a fetal heartbeat should be confirmed by auscultation with a Doppler handheld device and a history taken to determine other risk factors for stillbirth or early onset FGR. [GPP]
If a woman presents with RFM prior to 24+0 weeks of gestation, the presence of a fetal heartbeat should be confirmed by auscultation with a Doppler handheld device. [GPP]