From the Guidelines
Increased fetal movement is generally considered a reassuring sign of fetal well-being and does not typically require medical intervention, as stated in the American College of Radiology's guidelines for assessment of fetal well-being 1.
Key Points to Consider
- Normal fetal movement patterns typically develop around 18-20 weeks of pregnancy and increase until about 32 weeks, after which they stabilize.
- Most healthcare providers recommend monitoring fetal movements daily in the third trimester using kick counts, where you count how long it takes to feel 10 movements.
- A sudden increase in movements might occasionally indicate fetal distress, as the baby may be responding to decreased oxygen levels with increased activity before movements decrease.
- Other causes of increased movement can include maternal consumption of caffeine or sugar, external noise or light stimulation, or simply the baby's normal wake-sleep cycle.
Recommendations for Monitoring Fetal Movement
- If you notice a sudden, significant increase in fetal movements, especially if accompanied by pain or discomfort, you should contact your healthcare provider for evaluation.
- During your prenatal appointments, always discuss any concerns about fetal movement patterns with your healthcare provider, who can perform additional monitoring if necessary to ensure your baby's well-being, as suggested by the American College of Radiology's guidelines 1.
Importance of Fetal Movement Monitoring
- Antenatal fetal surveillance is crucial for identifying fetuses at risk for intrauterine demise, and a normal result for any test of fetal well-being is highly reassuring 1.
- However, there is no evidence that routine antenatal testing improves outcomes in pregnancies perceived to be low risk, and antenatal fetal surveillance in low-risk women has the potential to cause iatrogenic prematurity secondary to preterm delivery for false-positive results 1.
From the Research
Increased Fetal Movement
- Increased fetal movement can be a sign of fetal compromise, which may indicate underlying disturbances in the in utero environment 2.
- A sudden increase in fetal movements can be a sign of acute fetal distress, such as cord complications or abruptio placentae 3.
- Fetal movements are an expression of fetal well-being, and changes in fetal movement patterns can be an indicator of fetal distress or compromise 3.
Association with Fetal Distress
- Increased fetal movements have been associated with fetal seizures induced by asphyxia or infection, attempts to release cord entanglement, or changes in fetal behavior in response to a noxious stimulus 2.
- Fetal distress can be identified using various modalities, including ultrasound, continuous heart rate monitoring, and timely fetal scalp pH assessment 4.
- Decreased fetal movements are seen in cases of chronic fetal distress, such as preeclampsia or hypertension in pregnancy 3.
Maternal Perception and Education
- Maternal perception of fetal movements is an important aspect of fetal monitoring, and education on normal fetal movement patterns can help women identify potential issues 5, 6.
- Women who are educated on fetal movements are more likely to seek assessment promptly if they experience decreased fetal movement 5.
- A diurnal pattern of fetal movement, with stronger movements in the evening and at night, is a normal pattern in healthy pregnancies 6.
Clinical Implications
- Increased fetal movements can be a sign of fetal compromise, and further examination is warranted in such cases 2.
- Fetal movement monitoring can be used as a tool to reduce perinatal mortality rates, particularly when used in conjunction with other modalities such as ultrasound and heart rate monitoring 2, 3.
- Healthcare providers should be responsive to concerns about decreased fetal movements, particularly in the evening, as this is unusual and may indicate fetal distress 6.