Management of a woman whose singular complaint is reduction of Fetal movement

Appropriate management of a woman presenting with a sole complaint of reduced fetal movement includes:

• Assess the woman and the baby promptly to evaluate fetal wellbeing and identify any risk factors or complications. This assessment should include a detailed history and clinical examination.
• Offer cardiotocography (CTG) to monitor the fetal heart rate pattern to detect any signs of fetal compromise.
• Measure amniotic fluid volume (liquor volume) as part of the assessment to check for abnormalities that may indicate fetal distress.
• Perform an ultrasound scan to assess fetal growth and wellbeing, including consideration of umbilical artery Doppler if available, especially if there are concerns about fetal growth restriction or other risk factors.
• Advise the woman to report any further concerns about fetal movements at any time, emphasizing the importance of ongoing fetal movement awareness after 24 weeks of gestation.

This structured approach aligns with the management plan described in the AFFIRM trial and NICE antenatal care guidelines, which recommend a combination of fetal heart rate monitoring, liquor volume measurement, and growth scans following reports of reduced fetal movements ¹.