NURS 680B Week 6 Discussion Advanced Health/Physical Assessment

Fetal movements felt by pregnant women are a sign that the fetus is growing in size and strength. The pregnant woman is usually the first to feel these movements, which can later be perceived by others. Women are often taught by their health care provider to monitor or be aware of the movements of the fetus. This can be a general awareness of fetal movements, or the women can be taught to count the number of kicks they feel in a set amount of time. Reduced fetal movement can be worrisome for both the mother and the attending healthcare provider. Decreased fetal movement can be a warning sign of potential fetal impairment or risk, and therefore, warrants further evaluation by the healthcare provider.[1][2]

The first fetal movements which are felt by the mother are called quickening. One function of these movements is to alert the pregnant woman that she has a fetus growing in her uterus. Quickening often occurs between the 16th to the 22nd week of pregnancy. This is called a presumptive sign of pregnancy as the other movements of the woman’s body can mimic early fetal movements such as flatus, peristalsis, and abdominal muscle contractions. A multiparous woman will usually first notice these fluttering movements of the fetus at an earlier gestation than a primiparous woman. A multiparous woman might feel movements as early as 16 weeks, whereas a primiparous woman may not feel anything until 20 to 22 weeks. At around 20 weeks of gestation, the trained healthcare provider can feel fetal movement externally through the abdomen. This is considered a positive sign of pregnancy.[3]

Most providers recommend that pregnant women monitor fetal movements, especially by the third trimester. This can be accomplished by simply instructing the woman to have a general awareness of the fetus and determine if the fetus is moving less than normal on any given day or about the same as other days. Alternatively, healthcare providers might recommend a more formal fetal movement count (FMC), sometimes called a kick count. Clinicians often recommend starting this surveillance around 28 weeks gestation and continuing throughout the remainder of the pregnancy. The “count to 10” method includes the instructions for the woman to count fetal movements at the same time each day. If the woman experiences less than ten movements in a 2 to 3-hour period, she is instructed to contact her healthcare provider. One study noted that having women count fetal movements can improve maternal-child bonding during pregnancy as the mother starts to get to know her unborn child.[3]

Issues of Concern

The issues of concern would include perceived or actual decreased fetal movement. Historically, cases of a compromised fetus or infant have usually been preceded by decreased fetal movement. Therefore, the assumption is that if a woman notices a decrease in fetal movement and has it evaluated, then a possible adverse event with the fetus might be avoided by the use of interventions. Many studies have attempted to verify a correlation between decreased fetal movement and placental functioning, abnormalities of the uterus, fetal growth restriction, twin to twin transfusion, tight nuchal cords, or to demonstrate that kick counts can prevent intrauterine fetal demise. Although this type of monitoring is often recommended, tracking does not always prevent complications. However, due to the low cost and potential benefit, it is recommended. Decreased fetal movement can indicate a need for more evaluation and has the potential to save lives. There is a worse outcome in pregnancies with reduced fetal movement, with one study demonstrating the highest incidence of poor outcomes in small for gestational age fetuses.[4]

One potential side effect of routine monitoring of fetal movement could be an increase in prenatal visits, either outpatient or inpatient. However, most research has not found this type of increase to be true. Usually, the fetal movement count (FMC) is reassuring to pregnant women and prevents unnecessary visits. The healthcare provider should remember that some women are more vigilant at fetal movement monitoring than others. Therefore other methods of surveillance might be needed if the mother of the baby is less likely to comply with the fetal movement count. Numerous studies are trying to determine various new methods to track fetal movements while the pregnant woman is at home or work. Some methods could allow a more consistent and objective method of measuring frequency and possible strength of movements. The advance of three-dimensional ultrasound has allowed researchers to study normal movements of the fetus throughout pregnancy. This includes facial expressions and rapid eye movement (REM) during sleep. The arm movements of twins compared to singleton births are being studied and evaluated. Researchers find that fetal movement changes throughout pregnancy and can indicate normal or abnormal development. It is of note that studies have shown that obese women can feel fetal movement as well as women with normal body mass index (BMI). However, due to more common maternal and fetal complications, obese women will likely notice decreased fetal movement more often than their lower BMI counterparts.[5][6]