Fetal Movement Monitoring: Recommended Methods and Response Criteria
Recommended Kick Counting Method
Mothers should be taught to monitor fetal movements during the last 8-10 weeks of pregnancy using daily self-assessment, with the most validated approach being the "count-to-10" method where women track the time required to perceive 10 distinct fetal movements. 1
Practical Implementation
Instruct women to begin formal fetal movement counting at 28-32 weeks gestation, particularly in high-risk pregnancies, though all pregnant women should maintain awareness of fetal activity patterns 1
The "Cardiff count-to-10" method is the most practical validated approach: women note the time required to feel 10 distinct movements, which should normally occur within 12 hours 2
Women should perform counting during periods when the fetus is typically active, often after meals or in the evening, to establish a baseline pattern of normal activity 1
What Constitutes Normal vs. Abnormal Movement
Fewer than 10 movements in 12 hours represents the threshold for concern and warrants immediate clinical evaluation 2
However, the quest to define a single quantitative "alarm limit" has been unsuccessful, and rigid numerical thresholds should be interpreted with caution as fetal activity patterns vary considerably between individuals 3
Any sudden, significant decrease in the woman's perception of her baby's usual movement pattern should prompt evaluation, even if it doesn't meet the numerical threshold, as maternal perception of change is clinically significant 1, 4
When to Contact a Provider
Women should be instructed to report immediately any reduction in the perception of fetal movements compared to their baby's established pattern, without waiting to meet specific numerical criteria. 1
Specific Scenarios Requiring Immediate Contact
Perception of decreased fetal movements from the woman's established baseline requires same-day evaluation with nonstress testing, regardless of whether a specific numerical threshold is met 1
Fewer than 10 movements in a 12-hour period is a clear indication for immediate clinical assessment 2
Complete cessation of movements or a pronounced decrease represents a "movements alarm signal" (MAS) indicating severely compromised fetus and potential impending intrauterine fetal death, requiring urgent evaluation 4
Sudden excessive fetal movements may paradoxically indicate fetal compromise (such as acute cord complications or abruption) and also warrants evaluation, though this is less well-established 4, 5
Clinical Response Algorithm
Initial Evaluation
When a woman reports decreased fetal movements, perform a nonstress test (NST) immediately to assess fetal oxygenation and acid-base balance, combined with ultrasound assessment of amniotic fluid volume to create a modified biophysical profile. 1
A reactive NST (≥2 fetal heart rate accelerations in 20 minutes) is highly reassuring, with stillbirth risk of only 0.8 per 1,000 cases within one week 1
Assess amniotic fluid volume simultaneously, as oligohydramnios (maximum vertical pocket <2 cm) may indicate chronic placental insufficiency even with a reactive NST 1
Escalation for Abnormal Findings
If NST is non-reactive, proceed immediately to full biophysical profile (BPP) including fetal breathing, body movements, tone, and amniotic fluid 1
If BPP score is ≤6, deliver immediately regardless of gestational age 1
If oligohydramnios is detected at term, proceed with delivery 1
Perform fetal biometry if not recently done to assess for growth restriction (estimated fetal weight <10th percentile), which would warrant umbilical artery Doppler assessment 1
Critical Caveats and Limitations
No antenatal test, including fetal movement monitoring, NST, or BPP, can predict stillbirth related to acute events such as placental abruption or cord accidents, which can occur even with recently normal testing 1, 6
The historical "movements alarm signal" described cessation of movements occurring 12+ hours before fetal death, emphasizing that decreased movements represent a late sign requiring immediate action rather than continued observation 4
Avoid rigid adherence to specific numerical thresholds alone for clinical decision-making, as maternal perception of change from her baby's normal pattern is the key clinical indicator 3
Fetal movement monitoring should be reserved for high-risk pregnancies in formal surveillance protocols, though all women should maintain awareness of their baby's movement patterns 1
Do not rely on fetal movement assessment alone to guide delivery decisions; always confirm with NST and consider additional testing as indicated 1, 2