A lot of this is what we already do. However there is a good flow chart at page 14. New things for me were:
- In a pregnancy with 2 or more episodes of reduced fetal movements (RFM), there is a worse outcome, so warn the mother to get checked each time.
- If a woman hasn’t felt movements by 24/40, refer, as there could be a fetal neurological problem.
- If < 24/40, just do Doppler in clinic (if can hear OK, don’t need to refer)
- If 24 – 28/40, there is no evidence regarding best management. They suggest that just doing a Doppler is OK. My experience is that local maternity units will happily see these women though – so personally, I’d still discuss it with the mat unit.
- If > 28/40 – refer to the maternity unit.
- If the woman isn’t sure whether there is RFM, get her to lie on her left side for 2 hrs. If she doesn’t feel 10 discrete movements, refer to maternity unit. If there are risk factors for still-birth (listed in the guidance), refer to the maternity unit, even if there turns out to be no RFM as this is a high risk pregnancy.
- Don’t advise women to look for a certain number of movements in a time span, as this causes a lot of anxiety and we don’t know what the correct numbers are, so advice is ‘compared to normal’.
