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Dr. Andrew Rynne

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Does reduced fetal movement at 31 weeks of pregnancy require medical attention?

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Dr. Richa Agarwal

OBGYN

Practicing since :1999

Answered : 3200 Questions

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Posted on Mon, 23 Apr 2018 in General Health
Question: Hello doctor, I had asked you few questions last month regarding fetal measurements, Blood report (B12, ESR) 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 31 weeks 5 days pregnant after IVF process. I have hypothyroidism (under control at the moment) and currently on Levothyroxine and iron supplements.

TimeLine:
Between 25 and 27 weeks: Good movements of baby. It was kind of regular and almost all day.
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.

In 29th weeks they did ultrasound scan and the baby growth was in line with normal range. Blood flow, heart rate etc was normal.

Between 29 weeks and 31 weeks my baby was moving very very well. Almost all day everyday with good intensity. My whole belly was moving.

Again three days ago (at 31weeks 1 day) my baby went very quiet. It hardly moved and there was no intensity. I mean I felt very few movements only but no big kicks. I would say about 4-5 time each hour. And for some hours no movements. I would say about 40-50 movements in TOTAL in a day. During 29-31 weeks baby was moving like 20-30 time each HOUR.

In UK, the advise is that if you feel LESS movement then normal you should go to the hospital for check up. I went hospital two days ago. They checked heartbeat. It was 145 bpm. They then did ultrasound scan and baby growth was in line with gestation. Scan's doppler readings (i think umbilical and blood flow) was normal. They said all are fine. nothing to worry. But they say if you notice reduction in movement I should go to hospital again.

Hospital here does not advise to count number of movements. They advise that you should know your baby's normal movement pattern as all babies are different. If it is reduced I should go for the check up.

I am confused and WORRIED. Compared to two weeks ago my baby's movement is definitely reduced but scan says all is fine.

I did ask other online doctor and he said as long as there is some movement, it is ok.

1> What is your opinion on this?

2> What is considered normal movements and when I should be concerned?
I have no previous experience of being mother so do not know what is called normal movement. I am very anxious.

4> I am very worried at the moment. Do you think because scan is normal, I should not worry another few days?

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

5> I went for private scan today. They also said all looks normal but AFI (amniotic fluid index) is lower side of normal range. They said it not abnormal but just the lower side of normal range (I think it is around 10th Percentile).
WHAT IS NORMAL AMNIOTIC FLUID and should I be worried at the moment?

6>How often I should go for checking of Amniotic Fluid?

7> Is there anything I can do to make Fluid rise again?

Please note: in all scan the baby's growth is in line with normal ranges.

Please Advise. I am worried because of bad history and first time pregnancy.

Awaiting your quick response. Sorry for the lengthy message.

Regards.
doctor
Answered by Dr. Richa Agarwal 2 hours later
Brief Answer:
At least 10 movements per day considered normal.

Detailed Answer:
Hello dear,
Thanks for trusting hcm about your health care.
I have gone through your history in detail and understand your concerns.
You can count 10 movements per day ,it indicate your baby is fine.
As your usg is fine, you should not worry about it.
AFI should be more than 10.
If it is on lower side,than you have to drink a lot of water and take high protein diet and arginine XXXXXXX
You should take a healthy and nutritious diet and do not take much stress about it.
Hope found useful, feel free to ask more information.
Good luck.
Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Richa Agarwal 24 minutes later
Thank you doctor for your quick response.

Just to make things clear I would like more information.

Four days before I had a scan at hospital but they did not comment anything on AFI. They said all is ok. I read on internet that Fluid can fluctuate during the day.

1> Is it true that amniotic fluid fluctuate and if I do another scan couple of days later the AFI may change?

3> Why AFI may have dropped? Any serious issues?

2> Will drinking water and resting will help the level go up?

3> Doctors here do not prescribe arginine unless I fall under risk pregnancy. Do you think if I don't get arginine the diet alone will be ok?

4> Do you think I should keep on doing regular USG(scan)? If yes, at what intervals (like every two days or every week or every two weeks)

5> I do work monday to friday in a office (no hard physical work). Do you recommend I cut down on work? Or is it good exercise to work?

Awaiting your reply.

Thanks again.
doctor
Answered by Dr. Richa Agarwal 2 hours later
Brief Answer:
Yes, it may change.

Detailed Answer:
Hello dear,
You are always welcome and thanks for your information.

Here are the answers to your questions:

Yes, amniotic fluid can have fluctuations during days.

Drop in the amniotic fluid due to so many causes like oligohydramnios in IUGR.

If the level below the level than it may affect your baby but if the baby is fine with low levels no need to worry.

You can go for the scan in every one or two weeks depends upon your level.

You can take high protein diet and lots of liquids to improve your amniotic fluids.

You should continue your office work, it will not cause any harm to your baby.

Hope you found these useful.

Good luck.
Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee
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