Enhancing Fetal Well-Being: Analysis of Antenatal Awareness and Practice of Fetal Movement Monitoring

Abstract

Maternal perception of fetal movement is recognized as an important indicator of fetal well-being1.Passive, unstimulated fetal activity begins as early as the seventh week of gestation and becomes progressively more coordinated and purposeful toward the end of pregnancy2. Most pregnant women perceive fetal movements between 18 and 20 weeks of gestation, although multiparous women may detect them as early as 16 weeks3. Initially, these movements are faint and may be mistaken for intestinal activity, but as neuromuscular development continues, the movements become stronger, more rhythmic, and sustained2 . Fetal movements are broadly categorized as generalized and small movements. Generalized movements, such as stretching, kicking, and rollovers, are typically perceived by the mother4 .Small movements, including gripping, non-nutritive sucking, tongue protrusion, finger and toe flexion, and fetal breathing movements, are not usually perceived5 . The frequency and strength of perceived fetal activity in late gestation largely reflect the vigor of generalized body movements involving the trunk and lower limbs2 .In response to adverse intrauterine conditions, the fetus exhibits physiological adaptations aimed at conserving energy.6 These include redistribution of blood flow away from non-vital organs, often resulting in a reduction in overall body movement.6 Decreased fetal movements (DFM) may therefore signal chronic placental insufficiency and fetal growth restriction.7 DFM has also been associated with congenital anomalies, chromosomal disorders, intrauterine infections, hypoglycemia, oligohydramnios, neurodevelopmental impairment, threatened preterm labor, umbilical cord complications, emergency delivery, induction of labor, cesarean birth, stillbirth, and neonatal death.7,8 In many cases of intrauterine fetal demise, a reduction or cessation of movement is reported several days beforehand, supporting the concept that fetal movement monitoring may help detect early deterioration.1,9Fetal movement monitoring functions as an indirect assessment of central nervous system integrity.5 The increasing coordination of fetal body movements reflects neurological maturation similar to that observed in preterm infants.2Monitoring is particularly valuable in cases of prolonged placental insufficiency.6 A sudden reduction in movement is considered a clinically significant finding and has therefore been proposed as a simple screening tool for fetal compromise.1 Conversely, the presence of vigorous movements is generally reassuring.1 When perceived fetal activity decreases, further evaluation of underlying maternal or fetal complications is warranted, typically through fetal heart rate monitoring or ultrasonography.8 Women presenting with DFM face an increased risk of adverse pregnancy outcomes.7 The American College of Obstetricians and Gynecologists (ACOG) recommend maternal fetal movement counting (“kick counting”) as an effective and non-invasive method for monitoring fetal well-being.10 However, awareness and practice of kick counting among expectant mothers remains suboptimal.4 Growing evidence suggests that maternal education on fetal movement monitoring may help reduce adverse outcomes, including stillbirth.3,9Kick counting allows women to recognize their baby’s usual movement pattern and detect deviations early.10 Although not all stillbirths are preventable, research indicates that many cases are preceded by warning signs such as decreased fetal activity, offering a potential opportunity for timely medical intervention.7,8 This study aims to assess the knowledge and practice of fetal movement monitoring among antenatal women attending the antenatal OPD.