From the Guidelines
Evaluation of a pregnant patient complaining of increased fetal movement should begin with a thorough history and physical examination, including determination of gestational age and assessment for associated symptoms like pain, contractions, vaginal bleeding, or fluid leakage, as increased fetal movement can occasionally indicate fetal distress or hypoxia 1. The patient's history should include questions about the timing, frequency, and intensity of movements. A complete physical examination should be performed, including vital signs, fundal height measurement, and assessment for uterine tenderness or contractions.
- Electronic fetal monitoring should be conducted for at least 20-30 minutes to evaluate fetal heart rate patterns and detect any signs of fetal distress.
- An ultrasound may be indicated to assess fetal size, amniotic fluid volume, placental location, and fetal activity. Some potential causes of increased fetal movement include:
- Maternal ingestion of stimulants (caffeine, certain medications)
- Maternal hypoglycemia
- Certain fetal conditions If monitoring reveals concerning patterns or if the patient reports extremely vigorous movements, hospitalization for continued monitoring may be necessary. Patients should be educated about normal fetal movement patterns and instructed to report significant changes in movement patterns, especially decreased movement, which is more commonly associated with fetal compromise 1. It is essential to note that while increased fetal movement is often normal and reassuring, it can occasionally indicate fetal distress or hypoxia as the fetus gasps for oxygen 1. Therefore, a thorough evaluation and monitoring are crucial to ensure the well-being of the fetus. The use of Doppler assessment, such as umbilical artery Doppler velocimetry, can also be valuable in evaluating fetal well-being, especially in cases of suspected fetal growth restriction 1.
From the Research
Evaluation of Pregnant Patient Complaining of Increased Fetal Movement
- The patient's complaint of increased fetal movement should be taken seriously and evaluated promptly, as it may be a sign of fetal compromise or distress 2, 3, 4.
- A thorough medical history and physical examination should be performed to identify any underlying conditions that may be contributing to the increased fetal movement 5.
- Fetal non-stress test and other diagnostic tests such as cardiotocography and ultrasonography of the fetus and cord may be used to evaluate fetal well-being and identify any potential complications 5, 2.
- The patient's perception of fetal movement should be assessed and recorded, and high-risk pregnant women should be instructed to monitor and record fetal movements daily as a monitor of fetal condition 3.
- Increased fetal movements may be associated with adverse neonatal outcomes, such as large for gestational age (LGA) 5, and may also be a sign of acute fetal distress, such as cord complications or abruptio placentae 3.
- The presence of fetal seizures or umbilical cord entanglement could be evaluated at the time of presentation by cardiotocography and ultrasonography of the fetus and cord, and exposure to infection or noxious stimuli could be evaluated by maternal history and measurement of maternal blood for inflammatory markers or toxins 2.
- Fetal outcome following excessive fetal movements can be recorded after birth, and the presence of perinatal asphyxia can be assessed using Apgar scores, assessment of fetal acidaemia or measurement of stress-related factors in umbilical cord blood 2.
Key Considerations
- Increased fetal movements are not always reassuring and may be a sign of fetal compromise or distress 4.
- A timely assessment of the fetus is crucial to identify those women at risk of adverse fetal outcomes who may benefit from intervention 4.
- Emerging data suggest that 10-30% of women who subsequently suffer a stillbirth describe a single episode of excessive fetal movement prior to fetal demise 4.