Fetal Movement

One form of fetal monitoring that the mother-to-be can perform is fetal movement counting. Normal fetuses move with some regularity, and a possible sign of a fetus in trouble would be if the he or she stops moving. A fetus that had been moving according to its normal pattern but then stops moving may be giving a sign that it is not receiving enough oxygen. More commonly, it simply means that the fetus has been asleep, or that the mother is distracted and has not been focusing on her baby's movements.

A common way for mothers to assess fetal movement is by doing kick counts. One way of doing these is to have the mother lie down with her hand on her abdomen, and focus only on fetal movements for a period of one hour. There are several variations of how the counting should be evaluated, ranging from at least three movements in an hour, to repeated daily assessments to determine how long it takes her unborn baby to reach ten movements. If it generally takes a certain amount of time to reach ten kicks, and on a particular day it does not reach a this number within a given time, the mother should notify her obstetrician or midwife, who probably will recommend a nonstress test. In the vast majority of cases, the fetus is doing well, but on rare occasions the nonstress test will be nonreactive, and the lack of movement actually may be a sign of worsening fetal condition.

All of these methods of antepartum fetal assessment assess adequacy of oxygen delivery to the fetus. Reassuring testing correlates well with normal birth outcomes within a week of the test. If conditions that warranted the original test persist, these tests often will be repeated at weekly intervals. In general, as long as testing is reassuring, pregnancy can be continued. When testing is nonreassuring, a decision must be made whether the risks of remaining undelivered outweigh the risks of premature delivery. The closer the pregnancy is to the due date, the less the risk of prematurity and the greater the chance that delivery will be the response to an nonreassuring test. Labor may be induced, or for very nonreassuring heart rate patterns, cesarean section may be safer. The more premature the pregnancy, the more the obstetrician may be inclined to continue the pregnancy, however, given the fact that all these tests have a certain false-positive rate. Whatever the case, the goal of antepartum testing is to allow decisions to be made about which pregnancies should be allowed to continue, and which would be better off delivered before the baby’s health is seriously at risk.

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