Management of Decreased Fetal Movement
Initial Assessment and Risk Stratification
- The American College of Obstetricians and Gynecologists recommends a comprehensive ultrasound examination, including fetal biometry, amniotic fluid volume assessment, and umbilical artery Doppler velocimetry, to exclude chronic placental insufficiency and growth restriction in patients with decreased fetal movement at 26.6 weeks gestation 1, 2
- Fetal growth restriction is defined as an estimated fetal weight <10th percentile, and severe fetal growth restriction is defined as an estimated fetal weight <3rd percentile, requiring weekly surveillance 2
- Oligohydramnios is associated with placental insufficiency and requires close monitoring 1
- Abnormal umbilical artery Doppler, including increased pulsatility index >95th percentile, is associated with poor outcome and requires weekly surveillance 2
Management of Abnormal Findings
- For severe fetal growth restriction (EFW <3rd percentile) or abnormal umbilical artery Doppler, weekly umbilical artery Doppler evaluation and weekly cardiotocography testing are required 2
- For decreased diastolic flow (PI >95th percentile but present end-diastolic velocity), weekly umbilical artery Doppler surveillance and delivery at 37 weeks gestation are recommended 2
- For absent end-diastolic velocity (AEDV), Doppler assessment 2-3 times per week, daily cardiotocography monitoring, and administration of antenatal corticosteroids are recommended 1, 2
- For reversed end-diastolic velocity (REDV), immediate hospitalization, cardiotocography 1-2 times daily, and administration of antenatal corticosteroids and magnesium sulfate are recommended 1, 2