Enf.º Tito Félix

Maternal and Obstetric Health Specialist Nurse 
Gynecology and Obstetrics Service

Surveillance of fetal movements

HPA Magazine 23 // 2025

Foetal movements are one of the most important indicators of a baby's well-being during pregnancy.
Maternal perception of these movements plays a crucial role in monitoring foetal health, allowing risk situations to be identified early and serious complications prevented.

Maternal Perception of Foetal Movements
The perception of foetal movements usually begins in the 2nd trimester of pregnancy and may occur later in the first pregnancy (18-21 weeks) compared to subsequent ones (16-18 weeks).
The baby's movements are unique and specific to each foetus, so it is essential that the pregnant woman recognizes her baby's usual pattern. Often, periods of greatest activity occur late in the day or early in the evening.
Overall foetal activity increases progressively until 28 weeks and then stabilizes until the end of pregnancy. As the foetus matures, it establishes a circadian rhythm, alternating periods of sleep and wakefulness. Periods of deep sleep, with less perception of movement, can last between 20 and 40 minutes.
Importance of Foetal Movements
Monitoring foetal movements allows the mother to:
• Ensure foetal well-being in a non-invasive way.
• Early identification of changes in the baby's vitality.
Decreased foetal movement (DFM) is a common cause of concern and requires immediate evaluation. This situation may be associated with foetal hypoxia, intrauterine growth retardation, or even more serious situations such as intrauterine foetal death.
Recent studies, such as those conducted by the Royal College of Obstetricians and Gynecologists, show that pregnant women with DFM have a higher foetal mortality rate (8.2/1000 births versus 2.9/1000 in the general population).

Factors that Influence the Perception of Foetal Movements
• First pregnancy: The perception of movements may occur later.
• Excess weight: It can make it difficult to detect movements due to accumulated abdominal fat.
• Smoking: It can reduce the amount of foetal movement, interfering with the oxygenation of the foetus.
• Prolonged fasting: May affect foetal activity, as maternal glucose has a direct impact on the energy available to the foetus.
• Maternal position and activity: Certain positions (such as lying on the back) can reduce the perception of movement.
• Sedatives and alcohol: Can decrease foetal activity and affect the mother's perception.
• Anxiety and maternal stress: Emotional changes can interfere with the pregnant woman's attention to the baby's movements.
• Position of the placenta (anterior): May attenuate the sensation of movements.
• Baby's position and amount of amniotic fluid: Foetal position and amniotic fluid volume can influence the pregnant woman's sensitivity to feeling foetal movements.

How to Monitor Foetal Movements?
Monitoring foetal movements can be carried out by the pregnant woman herself, in a simple and effective way. Women should count their baby's movements, trying to feel at least 10 movements in a 2-hour period. This count can be done several times a day, especially if there is any concern about decreased foetal movement.
In situations of less foetal activity, the pregnant woman should first try a more comfortable position (such as lying on her side) and eat something light. If, even after this, the mother notices that the baby moves less or does not reach 10 movements in two hours, she should immediately seek clinical evaluation, without postponing it until the next day.

When to Seek Medical Assistance?
You should contact your attending physician or obstetric emergency service if:
• After 24 weeks of pregnancy, you still haven't felt foetal movements.
• The baby moves less than his usual pattern.
• After 2 hours of rest, lying on his side and after eating something, the baby did not perform 10 movements.

KICK COUNT METHOD

Pregnant women should feel at least 10 foetal movements within 2 hours, especially when at rest and after a light meal. This simple method can be done as follows:
1. Lie on your left side.
2. Concentrate and count every movement of the baby (kicks, turns, flutters).
3. If you do not reach 10 movements in 2 hours, seek immediate assistance.

Changes in Movement Pattern
Reduced or absent foetal movements should be considered an obstetric emergency. You should never delay seeking medical care.

DON'T FORGET

Surveillance of foetal movements is a fundamental strategy
for monitoring the baby's well-being during pregnancy.

Recognizing normal patterns and identifying
changes are vital to preventing risky situations.

Pregnant women should trust their instincts and seek assistance
whenever necessary, as early detection of problems can save lives.