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Reduced Fetal Movements as a Predictor of Fetal CompromiseDr. Meenu Sharma

Lancashire Teaching Hospital NHS Trust, Preston, UK.

Objectives and Methodology Second Case Conclusions

1. Reduced fetal movements: Green-top Guideline 57. RCOG 2011.

Objective:

Maternal satisfaction with perceived fetal movements is a good predictor of fetal well being. Aim of this case report is to raise awareness among health care professionals regarding the importance of monitoring pregnant woman after first episode of reduced fetal movements.

Methodology:  We present two case reports with first episode of reduced fetal movements .

CTG 1

CTG 2

First Case

First case is of a 30 years old, gravida 2, para 1 woman, who was rhesus negative with rhesus positive partner. She achieved vaginal delivery in her first pregnancy after induction of labour at term because of mild preeclampsia. Her booking blood investigations were normal with normal combined test for down’s syndrome screening in index pregnancy. She had received routine anti D prophylaxis. She was normotensive with no signs or symptoms of pre eclampsia. She presented at 35 weeks with reduced fetal movements for 48 hours. There was no history of bleeding per vaginum, abdominal pain or abdominal trauma. Symphysis fundal height was equivalent to gestation age. CTG was pathological with sinusoidal trace. A very pale baby was delivered with haemoglobin of 3.6 gm % at birth by category 1 caesarean section. Kleihauer test revealed 71 ml of fetal cells in maternal circulation. Baby was admitted to neonatal unit and made good recovery after receiving blood transfusion. The investigations concluded it as a case of severe, acute and spontaneous fetomaternal haemorrhage.

Second case is of a 35 yrs old gravida 3, para 2 woman. Her booking blood investigations were normal. Combined test for down’s syndrome screening revealed raised nuchal translucency ( 4.5 mm). Subsequent chorionic villous sampling and fetal anomaly scan were normal. She presented at 34 weeks with history of reduced fetal movements for 48 hours. CTG monitoring showed sinusoidal trace. An ultrasound scan showed gross hydrops. Baby was delivered by emergency caesarean section with abnormal cord gases and required resuscitation. He made a slow but good recovery. Investigations concluded chylothorax.

Every unit should have a local protocol consistent with national guidance on reduced fetal movements. All pregnant women should be given information about the importance of satisfactory fetal movements at booking and this should be checked at each antenatal visit in third trimester. Women with additional risk factors should be monitored closely with provision of written information at booking visit.

Sinusoidal CTG Trace

OPTIONALLOGO HERE

OPTIONALLOGO HERE

Objective: Maternal satisfaction with perceived fetal movements is a good predictor of fetal well being. Aim of this case report is to raise awareness among health care professionals regarding the importance of monitoring pregnant woman after first episode of reduced fetal movements.Objective: Maternal satisfaction with perceived fetal movements is a good predictor of fetal well being. Aim of this case report is to raise awareness among health care professionals regarding the importance of monitoring pregnant woman after first episode of reduced fetal movements.

Conclusion

References