Pregnancy - Fetal movements

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 4^th 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 9^th 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 5^th month of pregnancy (18-20^th week).  A sensitive gravida can perceive movement as early as 16^th 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 5^th month gradually increases till 8^th month.  In the 9^th month the movements may not be as many as felt in 7^th and 8^th 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.