**7. Management of second and subsequent presentations**

Up to 5% of women will re-present with reduced FM (Sinha *et al*., 2007). If the perception of reduced FM persists, consideration should be given to other causes such as fetal structural anomalies (4.3%), anaemia or feto-maternal haemorrhage. There is little evidence how to manage these pregnancies, however women who present on two or more occasions with reduced FM are at increased risk of poor perinatal outcome compared with those who attend only once (OR 1.92; 95% CI 1.21 – 2.02) (O'Sullivan *et al*., 2009). A practical approach would be to perform ultrasound assessment to rule out SGA, structural anomalies and oligo- or polyhydramnios and invite the woman for daily CTGs until mother and clinician are reassured. A blood test should ultimately be considered looking for maternal metabolic disorders or feto-maternal haemorrhage. Smoking should be discouraged. If concerns persist in later gestation, induction of labour or delivery can be considered.
