Intended for healthcare professionals

Practice 10-Minute Consultation

Reduced fetal movements

BMJ 2018; 360 doi: (Published 06 March 2018) Cite this as: BMJ 2018;360:k570
  1. Adam D Jakes, academic clinical fellow in obstetrics and gynaecology1,
  2. Rebecca Whybrow, clinical research midwife2,
  3. Clare Spencer, general practitioner3,
  4. Lucy C Chappell, NIHR research professor in obstetrics4
  1. 1Guy’s & St Thomas’ Hospital NHS Trust, London, UK
  2. 2King’s College London, London, UK
  3. 3Meanwood Group Practice, Leeds, UK
  4. 4King’s College London, St Thomas’ Hospital, London
  1. Correspondence to: A D Jakes adam.jakes{at}
  • Accepted 30 January 2018

What you need to know

  • Reduced fetal movements are associated with adverse pregnancy outcomes in pregnancy, including stillbirth, fetal growth restriction, placental insufficiency, and congenital malformations

  • Perform clinical assessment of a woman with reduced fetal movements including symphysis-fundal height measurement and fetal heart auscultation

  • Listen to the woman’s concerns and refer her to the nearest maternity unit if she remains worried

A 28 year old woman who is 32 weeks pregnant with her first baby tells you that, in the past 24 hours, she has not felt her baby move as much as usual.

A reduction or change in fetal movements can be a warning sign for adverse outcomes in pregnancy. This article aims to help healthcare professionals become more familiar with how to assess, counsel, and decide when to refer a woman presenting with reduced fetal movements.

The perception of fetal movements is subjective. Most women become aware of fetal movements by around 18-20 weeks’ gestation, which may be felt as “a discrete kick, flutter, swish, or roll.”1 Nulliparous women may first become aware of fetal movements at a later gestation.2 Fetal movements usually increase in number up to 32 weeks’ gestation before reaching a plateau; fetal movements do not reduce in healthy late pregnancy and do not reduce before normal labour. They tend to become more frequent later in the day, and absent during fetal sleep cycles (lasting 20-40 minutes).13 Women will come to learn the normal pattern of their baby’s movements, which can vary considerably between women. A woman is said to have a reduction in fetal movements when there has been a decrease or change in her baby’s normal pattern of movements. The Royal College of Obstetricians and Gynaecologists (RCOG) guidelines from 2011 did not recommend formal daily counting of fetal movements or “kick-charts” as they had …

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