Reduced fetal movements: time to move on?
Every stillbirth is a tragedy; around half present with absent or reduced fetal movements (RFMs). This association inevitably leads to “what if” among parents and staff: could birth have been undertaken before stillbirth occurred? It also means that despite being a symptom, RFMs is ‘associated with’ stillbirth and indeed with its causes such as fetal growth restriction (FGR).
Fetal movement initiatives have become widespread. These encourage presentation, and the ‘symptom’ of RFMs has massively increased1. This is combined with management advice: In the UK, RFMs is a cornerstone of a stillbirth reduction strategy and now a major indication for induction of labour. A further particular concern is ‘recurrent’ episodes of RFMs.
Are these initiatives effective? Does the evidence support them? Why and when are movements reduced or perceived to be so? And could there be collateral damage?