Once a woman is pregnant she keenly observes all the changes
in her body. Just after three months of
pregnancy many worry about the size of their abdomen not increasing. Usually, until three months are over there
will be no apparent change in the abdomen.
The gravid uterus grows into the abdomen from 4th month
onwards. Slowly there will be fullness
or, if gravida is thin, bulge in the lower part of abdomen can be seen. This slowly increases till 9th
month. Later as the head enters the
pelvis – birth canal the height of uterus may decrease slightly. Any anxious gravida who conceives after
infertility treatment can feel reassured by feeling the increase in the size of
tummy.
The most important observation a gravida should have is of
fetal movements. Fetal movements are
generally felt in the 5th month of pregnancy (18-20th
week). A sensitive gravida can perceive
movement as early as 16th week of pregnancy. By 20 weeks they must be felt by the
gravida. The first perceived fetal
movement is called ‘quickening’. Once
the movements are felt they have to be perceived well until delivery. The perception of movements felt in the 5th
month gradually increases till 8th month. In the 9th month the movements may
not be as many as felt in 7th and 8th month. There is slight decrease as the fetus settles
down and head descends into the birth canal.
In high risk pregnancy – where pregnancy is complicated by
any other medical condition or pregnancy complication, gravida should observe
fetal movements regularly. Usually the
fetus’ resting time is 15-20 minutes.
Fetus generally moves at least once in every 15-20 minutes. In high risk pregnancy gravida is asked to
keep a count on fetal movements every day – Daily Fetal Movement Count (DFMC). Gravida is asked to count at least ten
movements and note the time taken for the same.
Every day within that same period of time she should feel ten
movements. If time increases day after
day fetal compromise is suspected.
To count 10 movements may take more than two hours and it
may be stressful to watch continuously for 2-3hrs. I advise my clients to observe fetal
movements for an hour - once immediately after waking up, again in the
afternoon and before retiring to bed.
She should feel four movements in an hour, three is must. The total movements felt in a day will be
10-12. If she cannot feel three movements she has to observe another hour and
feel 3-4 movements. Even in the second
hour if she is unable to feel at least three movements she has to consult. This is the way she can be assured of the
fetal movements, and well being and consult obstetrician at earliest if she
could not perceive movements as said.
This helps in decreasing sudden fetal deaths in late pregnancy. This simple clinical follow up advice has helped
me to save few babies at right time.
It is good that every gravida in late pregnancy keeps count
of fetal movements and consult the obstetrician when the movements are not felt
for more than two hours on observation.