Review NHS treatment of pregnant women experiencing reduced fetal movements

I want the Government to review how NHS clinicians respond when pregnant women report reduced fetal movement, and in particular the scans that are offered to assess the health of the baby.

I suffered a still birth and I had gone to the triage on three separate occasions with reduced fetal movements, I was examined with a Doppler that showed tachycardia then put on a CTG machine.

Currently only 1% of fetal tachycardia is sustained therefore a Doppler or up to 60 minutes on a CTG machine can miss these intermittent tachycardic episodes, whereas a full scan could see any abnormalities.

A review should look at whether current practice is fit for purpose, or should be reformed.

The National Institute for Health and Care Excellence (NICE) published antenatal care guidelines on 19 August 2021, including recommendations on monitoring fetal growth and wellbeing. These guidelines are aimed at clinicians working on the front line and are being implemented across maternity services in England. Under the guidance, clinicians should discuss the topic of the baby’s movements with the woman after 24 weeks and assess the woman and baby if there are any concerns. The woman should be advised to contact maternity services at any time if she has concerns about her baby’s movements or notices reduced fetal movement (RFM) after 24 weeks.

The Government is committed to patient safety and eradicating avoidable harms. Every baby loss is a tragedy and we are continuously working to make the NHS one of the safest places in the world to have a baby by offering mothers and babies better support and safer care.

Guidelines

The Royal College of Obstetricians and Gynaecologists published updated guidelines on “Reduced Fetal Movement” in February 2017. The guidelines provide advice based on the available evidence, to guide clinicians to provide the best most appropriate care to women presenting with reduced fetal movement during pregnancy.

According to the guidelines, when a woman reports reduced fetal movement, the priority is to confirm fetal viability. A handheld Doppler device will usually be used to confirm the presence of the fetal heartbeat.

This should be available in the majority of community settings in which a pregnant woman would be seen by a midwife or a general practitioner. The duration of recording is restricted to 20–30 minutes with the mother in a semi-recumbent position. There are no studies which have evaluated the use of longer periods of fetal movement counting by Doppler ultrasound or whether this method can detect fetuses at risk of stillbirth.

After fetal viability has been confirmed, if the pregnancy is over 28+0 weeks of gestation, the woman should undergo cardiotocography (CTG) monitoring of the fetal heart rate initially for at least 20 minutes, to detect fetal compromise. An ultrasound scan assessment should be undertaken as part of the preliminary investigations of a woman presenting with RFM after 28+0 weeks of gestation if the perception of RFM persists despite a normal CTG or if there are any additional risk factors for fetal grown restriction and stillbirth.

The Royal College of Midwives and Royal College of Obstetricians and Gynaecologists have developed a consensus statement on “Electronic Fetal Monitoring (EFM)”. This is a part of the toolkit used by midwives and obstetricians working together during a woman’s pregnancy and labour to monitor the fetal heart rate and check signs of compromise. Initiatives

The Saving Babies Lives care bundle was introduced in 2016 to tackle stillbirths and early neonatal deaths. The bundle comprises of four key elements which include reducing smoking in pregnancy; risk assessment and surveillance for fetal growth restriction; raising awareness of reduced fetal movement; and effective fetal monitoring during labour.

The four key elements are being implemented in all NHS maternity services. An independent evaluation of the Saving Babies Lives Care Bundle showed that stillbirths fell by 20% at the maternity units where implementation of the Care Bundle was evaluated. Version two of the Saving Babies’ Lives Care Bundle (SBLCBv2) was launched in March 2019, to build on version one and to address the issues identified in the evaluation.

The care bundle sets out that an ultrasound scan for fetal growth, liquor volume and umbilical artery Doppler needs only to be offered on first presentation of RFM if there is no computerised CTG or if there is another indication for scan (e.g. the baby is ‘Small for Gestational Age’ on clinical assessment). Ultrasound scan for fetal growth, liquor volume and umbilical artery Doppler should be offered to women presenting with recurrent RFM after 28+0 weeks’ gestation.

The Government will continue to work to develop policy and support initiatives to reduce stillbirths and provide better support and safer care for mothers and their babies.

Department of Health and Social Care