It can be terrifying when a pregnant patient or their partner sense their baby isn’t moving less in the womb, or not moving at all. Loss of fetal movement may be a red flag the fetus is not receiving sufficient oxygen in the womb. This condition is known as fetal hypoxemia. Medical studies show decreased fetal movement increases the risk of a poor outcome for the pregnant patient or their child. [1]
What should doctors and hospitals do when their patient senses a loss of fetal movement?
Hospitals and obstetricians are expected to recognize decreased fetal movement as a potential obstetrical emergency. Whenever a patient expresses concern about decreased fetal movement, obstetrical doctors and nurses should start by performing a prompt and careful history and physical examination.
Often, doctors or nurses may ask the pregnant patient to monitor and record kick-counts. However, current medical studies show conflicting data about whether measuring kick-counts improves the outcome of the pregnancy. Therefore, it is important for health care providers who care for pregnant patients to consider formal testing beyond kick-counts.[2]
What types of testing should be performed to evaluate loss of fetal movement?
One of the most common tests used to evaluate the loss of fetal movement is a nonstress test. A non-stress test involves use of an external fetal heart rate monitor strapped across the pregnant patient’s abdomen. An ultrasound transducer connected to the fetal heart rate monitor measures the fetal heart rate in utero and depicts the heart rate in the form of a tracing that looks like this:
For a fetus > 32 weeks of gestation, clinical practice guidelines from the American College of Obstetrics and Gynecologists (ACOG) recommend the nonstress test be performed over the course of 20 minutes. A “reactive” test demonstrates at least two increases, or accelerations, in the fetal heart rate at least 15 beats per minute above the heart rate baseline. Each acceleration should last at least 15 seconds for the test to be considered reactive. This is a reassuring test result and interpreted as a sign that the fetus remains well oxygenated. [3]
When accelerations in fetal heart rate are not present after 20 minutes of testing, the fetus may be asleep. In this scenario, the test may be extended to a total of 40 minutes.[4]
A biophysical profile is another important test obstetricians use to evaluate the well-being of a fetus. A biophysical profile is performed with an ultrasound machine. The ultrasound is used to evaluate for normal fetal tone (found when the fetus extends an extremity or their spine then returns to the flexed position), fetal breathing movements, fetal movement of a limb or part of the body, and an appropriate depth of amniotic fluid.
Each component of the biophysical profile is assigned a score of 2 points for a normal result or zero points for an abnormal result. Often, the biophysical profile is combined with a nonstress test to help assure the well-being of the fetus.
An abnormal or “nonreactive” nonstress test or biophysical profile should prompt further testing and evaluation of the pregnant person and their fetus. The obstetrician should consider maternal conditions that could account for the nonreactive stress test or medications which might have an effect on the fetal heartrate. In addition, obstetricians will often repeat the nonstress test to confirm the results. To help elicit fetal heart rate accelerations on the repeat nonstress test, the doctor may use a device to apply vibroacoustic stimulation to the mother’s abdomen. A normal or “reactive” stress test after a non-reactive stress test should provide reassurance to the pregnant patient about the health of the fetus.
Decreased or absent fetal movement are not the only reasons doctors might order a nonstress test and biophysical profile. A nonstress test of biophysical profile may be performed whenever there is concern for the fetus due to the following reasons:
- Preeclampsia
- Gestational Diabetes
- Fetal Growth Restriction
- Twin Pregnancy
- Oligohydramnios or Polyhydramnios
What can happen to a baby if they are not properly evaluated for loss of fetal movement?
When doctors fail to test patients with decreased or absent fetal movement, a medical malpractice lawsuit may be warranted on the following grounds:
- Delayed diagnosis of a condition that threatens the life of the fetus; or;
- The failure to perform an emergency C-section or other medical treatment essential to preserve the life and well-being of the fetus.
Without proper testing to identify and address problems in the womb as soon as possible, the fetus may be at increased risk of stillbirth. A newborn who survives labor and deliver may be at increased risk of injury to the brain resulting in cerebral palsy, cortical visual impairment, seizure disorders, or organ failure.
The law firm of Lupetin & Unatin, LLC can help you understand whether a doctor, nurse practitioner, physician assistant or other healthcare provider did everything necessary to protect your unborn baby from harm. Our lawyers are familiar with rules and guidelines doctors are required to follow to diagnose complications of pregnancy involving both the fetus and pregnant person. We work with experts renowned in their fields who will fairly assess whether a lawsuit is warranted. And we can speak for you as we pursue justice for what was taken from you or your family.
[1] Antepartum fetal surveillance. ACOG Practice Bulletin No. 229. American College of Obstetricians and Gynecologists. Obstet Gynecol 2021;137:e116–27.
[2] Id.
[3] Id.
[4] Id.
