39-wks pregnant woman comes to you for absent fetal movement for 2 days. Her general condition is good. No pain and no leak. NST is normal. How will you advise her?
a) Come back in 24hr
b) Come back in next routine follow-up after 1 week
c) Admit and induce
d) Admit and observe
e) Continuous CTG
Correct Answer: b) Come back in next routine follow-up after 1 week - Ref: RCOG (2011)
The initial goal of antenatal fetal surveillance in cases of RFM is to exclude fetal death. Subsequent to this, the aim is to exclude fetal compromise and to identify pregnancies at risk of adverse pregnancy outcome while avoiding unnecessary interventions. All clinicians should be aware of the potential association of decreased fetal movements with key risk factors such as FGR, small-for-gestational-age (SGA) fetus, placental insufficiency and congenital malformations.
If after discussion with the clinician it is clear that the woman does not have RFM, there are no other risk factors for stillbirth and there is the presence of a fetal heart rate on auscultation, she can be reassured. Women should be reassured that 70% of pregnancies with a single episode of RFM are uncomplicated. Clinical assessment of a woman with RFM should include assessment of fetal size with the aim of detecting SGA fetuses.
After fetal viability has been confirmed and history confirms a decrease in fetal movements, arrangements should be made for the woman to have a CTG to exclude fetal compromise if the pregnancy is over 28+0weeks of gestation.
Ultrasound scan assessment should be undertaken as part of the preliminary investigations of a woman presenting with RFM after 28+0 weeks of gestation if the perception of RFM persists despite a normal CTG or if there are any additional risk factors for FGR/stillbirth.