**6. Optimal management of reduced fetal movements prior to and beyond 24 weeks' gestation**

Reduced fetal movements prior to 24 weeks gestation should be managed with auscultation of the fetal heart and clinical examination (basic assessment). Between 24 and 28 weeks gestation evidence suggests that fetal heart auscultation is sufficient for assessment, however CTG can be performed. The evaluation of a CTG can be difficult at this early gestation and its interpretation can be improved by computerised CTG applying the Dawson & Redmond criteria. It is essential to carry out a basic assessment including comprehensive stillbirth risk evaluation. If clinical examination is suggestive of small fetal size, ultrasound for fetal biometry, liquor volume and congenital structural abnormalities is recommended.

Beyond 28 weeks gestation, CTG should be part of the assessment of women presenting with reduced FM (refer to section 5.1.3). Figure 1 summarizes the recommended management approach to women presenting with reduced FM after 28 weeks gestation.

Fig. 1. Reduced fetal movement assessment flowchart *(*Unterscheider *et al*., 2009)

Reduced Fetal Movements 217

This comprehensive review is based on current evidence and experience from expert groups and reflects good clinical practice. For the development of evidence-based guidelines the authors suggest further randomised controlled trials to assess the different suggested management plans. This is likely to be difficult given current established clinical practice and ethical difficulties surrounding trials in pregnancy. Therefore, a sensible approach to the management of reduced FM based on good clinical practice as set out in this chapter

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