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Reduced/change in foetal movements

Specialties > Obstetrics

Differential Diagnosis Schema 🧠

Maternal Factors

  • Maternal sedation: Use of sedative drugs (e.g., benzodiazepines, opioids) can reduce foetal movements.
  • Maternal obesity: Increased maternal adipose tissue may decrease the perception of foetal movements.
  • Maternal position: Lying supine may reduce the mother’s perception of movements.
  • Maternal hypoglycemia: Reduced glucose levels can decrease foetal activity.
  • Maternal stress or anxiety: May alter perception or reporting of foetal movements.

Foetal Factors

  • Foetal sleep cycles: Foetuses naturally have periods of reduced activity during sleep cycles.
  • Foetal compromise: Conditions such as foetal hypoxia, growth restriction, or foetal anaemia can reduce movements.
  • Oligohydramnios: Reduced amniotic fluid can restrict foetal movement.
  • Placental insufficiency: May lead to reduced foetal movements due to compromised oxygen and nutrient delivery.
  • Foetal anomalies: Structural abnormalities such as neuromuscular disorders may reduce foetal movement.
  • Intrauterine foetal death: A serious consideration in cases of persistent absence of movement.
  • Polyhydramnios: Excessive amniotic fluid may also alter the mother’s perception of movements.
  • Multiple pregnancies: Movement of one twin may mask reduced movements of the other.
  • Cord complications: Issues such as cord entanglement or prolapse can reduce or alter movements.
  • Preterm labour: Can lead to changes in foetal movement patterns.
  • Foetal infection: Intrauterine infections can lead to reduced foetal activity.

Key Points in History 🥼

History of Presenting Complaint

  • Onset: Determine when the mother first noticed a change or reduction in foetal movements.
  • Duration: Assess how long the reduction or change in movement has been present.
  • Frequency: Ask about the typical frequency of foetal movements and how this has changed.
  • Quality: Changes in the strength, pattern, or type of movements should be noted.
  • Aggravating/relieving factors: Explore if anything makes the movements more or less noticeable, such as food intake, maternal position, or activity.
  • Associated symptoms: Investigate symptoms such as abdominal pain, vaginal bleeding, or leaking of fluid.
  • Previous occurrences: Any history of similar episodes in the current or previous pregnancies.
  • Maternal perception: Understanding how the mother perceives the movement can provide clues to underlying issues.
  • Foetal activity monitoring: Inquire about any home monitoring methods used, such as kick charts.
  • Recent antenatal visits: Information from recent ultrasounds or Doppler studies may be relevant.
  • Maternal health changes: Any recent illnesses, medication changes, or lifestyle changes that could impact foetal movements.

Background

  • Obstetric history: Assess previous pregnancies, including any history of foetal growth restriction, stillbirth, or reduced foetal movements.
  • Medical history: Review maternal conditions such as diabetes, hypertension, or thyroid disease, which may affect foetal wellbeing.
  • Medication history: Review current medications, including recent changes or new prescriptions.
  • Substance use: Inquire about smoking, alcohol, or drug use, which may impact foetal health.
  • Social history: Consider the impact of social factors, such as support systems, housing stability, and employment status.
  • Family history: Assess for any familial conditions that may predispose to complications during pregnancy.
  • Nutritional status: Consider the mother’s diet, weight gain during pregnancy, and any recent changes.
  • Exercise: Explore the mother’s activity level, as excessive or insufficient exercise may affect foetal movements.
  • Recent infections: Inquire about any recent infections, particularly those that could affect foetal health, such as UTIs or viral infections.
  • Stress and mental health: Explore the mother’s mental health and any recent stressful events.
  • Environmental exposures: Consider exposure to toxins, chemicals, or high temperatures.
  • Allergies: Review any allergies, particularly if new medications have been introduced.
  • Immunization status: Ensure that the mother is up-to-date with recommended vaccinations during pregnancy.
  • Previous ultrasounds: Review findings from earlier ultrasounds for any evidence of foetal growth restriction or anomalies.
  • Antenatal care adherence: Assess the mother’s attendance at routine antenatal appointments and any missed opportunities for earlier detection of issues.

Possible Investigations 🌡️

Initial Investigations

  • Cardiotocography (CTG): To assess foetal heart rate patterns, including baseline rate, variability, and the presence of accelerations or decelerations.
  • Ultrasound: To assess foetal growth, amniotic fluid volume, placental position, and foetal movements.
  • Biophysical profile (BPP): A scoring system using ultrasound to assess foetal wellbeing, including breathing movements, body movements, tone, and amniotic fluid volume.
  • Doppler ultrasound: To assess blood flow in the umbilical artery, middle cerebral artery, and ductus venosus, particularly in cases of suspected foetal growth restriction or placental insufficiency.
  • Kick charts: Encourage the mother to count foetal movements over a set period of time, typically two hours.
  • Maternal blood tests: Full blood count (FBC), glucose tolerance test (GTT), and others as indicated to assess for underlying maternal conditions.
  • Amniocentesis: May be considered if there is suspicion of foetal infection or genetic abnormalities.
  • Fetal fibronectin test: May be used in cases of suspected preterm labour to assess the risk of delivery.
  • Maternal-fetal medicine consultation: In complex cases, referral to a specialist may be necessary for further assessment and management.
  • Urinalysis: To rule out urinary tract infection or preeclampsia as a cause of reduced foetal movements.
  • Infectious disease screening: If an intrauterine infection is suspected, consider TORCH screen (Toxoplasmosis, Other agents, Rubella, Cytomegalovirus, Herpes simplex).
  • Thyroid function tests: To assess for maternal thyroid dysfunction, which may affect foetal movements.
  • Serum bile acids: To rule out intrahepatic cholestasis of pregnancy, which can reduce foetal movements.

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Obstetrics