Fetal Movement Counting

1. Starting at 26 to 32 weeks, if your pregnancy has risk factors for adverse perinatal outcomes, it's crucial to begin daily monitoring of fetal movements. (I-A)

2. If you’re a healthy pregnant woman without these risk factors, it's still important to be aware of your baby’s movements in the third trimester. You should perform a fetal movement count if you notice a decrease in movements. (I-B)

3. If you notice fewer than six movements in a two-hour window, this is a sign that further assessment is needed. Please reach out to your healthcare provider or hospital as soon as possible. (III-B)

4. Should you report decreased fetal movements (less than 6 distinct movements within 2 hours), a thorough evaluation of both your status and that of your baby should be carried out. This typically includes a non-stress test and/or biophysical profile. If a fetal malformation has not been ruled out already, an anatomical scan should be performed before deciding on any further steps.

Based on the findings, here’s how management will be handled:

• If the non-stress test is normal and there are no risk factors, continue with daily fetal movement counting. (III-B)
• If the non-stress test is normal but there are risk factors or signs of intrauterine growth restriction or oligohydramnios, an ultrasound for a full biophysical profile or amniotic fluid volume assessment should be done within 24 hours. Continue with daily fetal movement counting. (III-B)
• If the non-stress test is atypical or abnormal, more tests (biophysical profile and/or contraction stress test and amniotic fluid volume assessment) need to be performed as soon as possible. (III-B)

For more detailed information, please refer to the Society of Obstetricians and Gynaecologists of Canada.