Fetal Movement Counting (FMC) 

AKA Fetal kick counts

Refers how many times a baby moves during a certain time.

The mom must feel at least 10 movements within 2 hours, but she would probably feel movements in less time than that, letting her know her baby is doing just fine. This is very important to do in the third trimester, noticing the baby movement changes can save his life on time.

This is very important to do in the third trimester, noticing the baby movement changes can save his life on time.

Why is important to count baby movements?

  • Reassures the mother about her baby well-being.
  • To identify growth-restricted fetuses
  • To identify placental abnormalities

Two ways to quantify fetal movements

  1. By instrumentation
  • Use of a tocodynamometer, an electronic device for monitoring and recording uterine contractions, this is mostly used during labor.
  • Use of ultrasound, where the baby can be visualized with sonography, can be used anytime during pregnancy.

2. By maternal subjective perceptions – around 90% accurate

  • This is how the mother becomes aware of her baby movements.
  • May be confused with fetal movement early in pregnancy where movements are strong enough: baby’s breathing movements and hiccoughs, as well as Braxton-Hicks contractions

Both are important to assess fetal well-being when there is a diminished fetal activity which may be an indicator of impending fetal death.

Fetal movements by gestational age:

  • 7 – 8 week
    • Baby’s movement start (mom still doesn’t feel these delicate movements)
  • 16 – 22 weeks
    • Mother starts to feel movements AKA quickening
    • Multiparas may feel movement sooner, around 16 weeks
    • Nulliparas or primigravida may not appreciate fetal movements until approximately 2 weeks later, around 22 weeks
  • 20 weeks
    • A trained examiner may detect fetal movements
  • 20 – 30 weeks
    • Baby body movements become more organized
    • Baby starts to show rest-activity cycles
  • 28 weeks
    • Start counting fetal movements, especially for a woman with identifiable risk factors
  • 29 – 38 weeks
    • Fetal movement is strongest
  • 36 weeks
    • Fetal movement continues maturating
  • 34 to 36 weeks
    • Start counting fetal movements, for women at low risk for uteroplacental insufficiency

Important determinants of fetal activity

1. Position of the placenta

  • An anterior placenta, will diminish the baby kicks and heart sound, because the placenta is located in front of the stomach, creating a cushion between the stomach and the baby.

Note: usually placenta position is at the top or the side of the uterus

2. Amniotic fluid volume

  • Having low or too much amniotic fluid may diminish baby kicks

Oligohydramnios (low amniotic volume), limits fetal activity because there is a restricted uterine space.

Polyhydramnios (too much amniotic volume) makes it’s difficult to feel fetal parts due to much fluid

3. Time of day

Diurnal variations

  • Most active late at night around 9:00 p.m. and 1:00 a.m.
  • Least active in the morning hours between 2:00 a.m. and 8:00 a.m.

4. Glucose levels

Makes baby more active

  • After eating a meal due to the increase in blood glucose in the mother’s blood
  • Late at night as blood sugar level in declining
  • If maternal blood glucose is very low < 60 mg/dl (3.3 mMol/L)

5.The Sleep-awake cycles

Are independent of the maternal sleep-awake state

Cycles vary from approximately 20 minutes to as much as 75 minutes. Commonly last around 23 min for term fetuses

6. Sound stimulus

Some babies may react positively by the voices of their parents

Most may react to very loud and disturbing noisy enviroments

7. Maternal smoking

Fetal activity may be diminished for as long as 80 minutes only with two cigarettes

Methods for fetal movement counting  

First, try to feel comfortable, choose a place where you feel peace. Lie on your side, left side is better, circulation is improved in this position.

There are two most common methods used:

1. Sadovsky’s Protocol (first developed in 1973)

Count fetal movement for three half hours to an hour periods (30 to 60 minutes) per day and calculate the number of movements per 12 hours

  • Count in the morning, at midday and in the evening.

Sum total of the three recordings are multiplied by 4 to give a 12 hour daily count.

  • ≥ 4 movements: reassuring, within the normal range
  • < 4 movements: continue for 1 hour, 2 or more.
  • < 10 movements in 6 hours or if movements become weak: contact health care provider.

2. Cardiff Count-to-Ten method

  1. Count up to 10 fetal movements in one counting session and records the time period in a chart
  2. Start at approximately the same time daily
  3. Chart how long it took to count 10 movements
  4. – If < 10 movements in 10 hours or amount of time to reach 10 movements increase: contact health care provider.

Evaluation with health care provider include

  • A nonstress test (NST) for fetal reactivity and fetal well-being

Further management may include

  • Observation
  • A contraction stress test (CST)
  • Induction of labor

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