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Hello doctor, I had asked you few questions last month

DOCTOR OF THE MONTH - Mar 2015
Mar 2015
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OBGYN, Maternal and Fetal Medicine
Practicing since : 2009
Answered : 4679 Questions
Question
Hello doctor, I had asked you few questions last month regarding fetal measurements etc. I now have some concerns I want to clarify.

Brief history about me: I am 34 years old, two previous early miscarriages and one ectopic. Currently I am 29 weeks 4 days pregnant after IVF process. I have hypothyroidism (under control at the moment) and currently on Levothyroxine and iron supplements.

Between 25 and 27 weeks I was feeling good movements of my baby. It was kind of regular and with reasonable intensity. In 28th week I felt less movement for two days and I called my hospital and they put me on CTG monitoring the same day. They found nothing abnormal. Then they repeated CTG another three times with gap of every three days and every time they found normal report.

After four CTG reports they did ultrasound scan yesterday (29 weeks 3 days) and the baby growth was in line with normal range. Blood flow, heart rate etc was normal.

Between 27 and 29 weeks my baby was moving in irregular pattern. For Two days baby was very active (kicking, moving etc) and then third day very very quiet. This kind of irregular pattern continues till now.

Again today I am feeling that my baby is quiet. Yesterday was quiet as well but yesterday's ultrasound was ok. I am not feeling any kicks with intensity. Only few minor movements like baby is turning side. These minor movements are also with reasonable time gap. Probably one minor movement every 10 minutes or so.

As I said during 25-27 weeks the movements were very frequent and with more intensity.
Now very less movements and with less intensity.

Hospital here advises that you should report any movement decrease and go for check up. They also advise that do not count kicks. Mother is in best position to tell when the movement has reduced. But they are not finding anything abnormal every time I have been there.

What is your opinion on this?
What is normal movement and when I should be concerned?

I have no previous experience of being mother so do not know what is called normal movement.

Last week my blood and urine was checked and found no infections, only little low on haemoglobin hence iron tablets.

I am very worried at the moment. Do you think because CTGs are normal, i should not worry another few days?

Awaiting your quick reply. Thanks.
Posted Fri, 1 Dec 2017 in null
 
 
Answered by Dr. Deepti Verma 1 hour later
Brief Answer:
No need to worry

Detailed Answer:
Hi dear,
I have gone through your question and understand the concerns.
Normal fetal movement count is done by counting the fetal movements (including kicks and movements) for one hour after each major meal (breakfast, lunch and dinner) , preferably in left lateral lying down position.
The count should be at least 3 in an hour after the meal and at least 12 total movements in a day.
If the movements are less than 12 a day, then it is abnormal and further testing by ultrasound and CTG is warranted.
If the CTG and ultrasound is normal, then it is indicative of normal fetal functions for next one week.
So, follow this method of fetal movement count and report to the hospital accordingly.
Moreover, if the CTG is normal , you should not worry for a week.
Hope you found the answer helpful.
Regards
Dr Deepti Verma
OBGYN
Maternal and fetal medicine specialist
Above answer was peer-reviewed by
 
Follow-up: Hello doctor, I had asked you few questions last month 20 hours later
Hello doctor,

Thank you very much for your reply.

Your guidance is very reassuring but it is very different from here in the UK.

In UK they advise to monitor reductions in movement and when you feel reduction you have to contact the hospital. They do not advise to count number of movements. My worry was according to the UK guidance. As I said two weeks before my baby was moving almost all day and night time major movements. Last two weeks during day time hardly any movements and night time minor movements. So I reported it and they monitored for ten days by CTG. All CTG were normal.

Yesterday after sending you a query through HCM I went home from work, taken dinner and sat in my bed. There was no noticeable movement. After one hour of dinner, baby moved a lot as it was moving two weeks ago. I recorded movements and they were about 20 movements in half an hour. Then again baby went quiet.

Although my baby's movements are reduced compared to two weeks ago, during the day time I feel about total 15-20 MINOR movements at large time intervals and night time about 10-15 movements in about two hour time slot. PLEASE NOTE that these movement numbers are lower than two weeks ago. Two weeks ago I was feeling about 5-6 movements each hour during the day.

I sometime monitor baby heartbeat through handheld home doppler and every time I find heartbeat at around 135BPM.

1> From now on should I be worried if baby moves about 10-15 times during whole day and night time about 10 times???

2> Is home doppler heartbeat findings reassuring or I should not rely on it?

3> Do you think because one day baby movements were ok so it can not go wrong the next day??

4> So far, my ultrasound scans, CTG, growth report, blood tests, urine tests are no indicative of problem. Do you think my pregnancy should not go wrong suddenly? If it can go wrong, what kind of problem has most chances to happen, such as stillbirth??

I am sorry to ask you a lot but as you know I am first time mother and I have very difficult history.

Kind Regards.
 
 
Answered by Dr. Deepti Verma 1 hour later
Brief Answer:
Do not stress out

Detailed Answer:
Hi dear,
Please feel free to ask all your queries.
1. As the fetus grows, the movements become less noticeable as now rounabout movements are less, and flickering movements of the fingers and toes are more. So, the number of movements you are perceiving are absolutely normal.
2. Hand held doppler gives accurate reading. Fetal heart rate should be between 110-160 beats per minute.
3. It is less likely to get the abnormal results if the fetal movements were normal the previous day.
4. Do not be so anxious and stressed. When everything is fine, there are absolutely nil chances of anything going wrong.
Be assured and optimistic and follow your treating obstetrician's advice.
All the best.
Regards
Dr Deepti Verma
Above answer was peer-reviewed by
 
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