Assessing in-utero activity

In-utero fetal activity is seen as the hallmark of fetal wellbeing and a vital marker in the routine surveillance of unborn babies, with a further advantage that it can be assessed regularly by the mother with no need for specialist equipment or in patient care (Mangesi and Hofmeyr, 2007). However, there is currently no consensus on what constitutes reduced fetal movements leaving clinicians with limited guidance on definition and, therefore, diagnosis and management (Hofmeyr and Novikova, 2012)

In addition to being a precursor to fetal demise, a reduction in the normal pattern of fetal movements can also be associated with a number of clinical problems including intrauterine growth restriction (IUGR) and, less commonly, fetal abnormalities; in the case of structural conditions, with an anterior placenta (Frøen et al, 2001; O'Sullivan et al, 2009). There is concern that those fetuses at increased risk of stillbirth, who may undergo circulatory adaptations to compensate for reduced utero placental perfusion, may be missed during traditional antenatal surveillance (Alfirevic et al, 2010).