Case: Reduce fetal movement

Question

a) Regarding traditional medicine, how to advice patient

b) Line of thinking to get diagnosis

c) Management.

Traditional medicine

A doctor has no right to order patient to stop taking traditional medicine. However, lack of study and information between interaction of traditional medicine and modern medicine may cause few un-expected side effect.

Furthermore, few manufacturers being dishonest by adding some ‘hidden’ ingredient inside their product which may cause serious side effect in reaction to certain drugs. Therefore, as a doctor we can advise patient to

1. Choose either taking only traditional or modern medicine or not combining them.

2. Suggest to them to stop traditional medicine while pregnant because afraid of unexpected side effect with prescribed medicine.

3. Use alternative traditional medicine that known scientifically not harmful like honey.

Line of thinking to get the diagnosis

1) Is mother really paying full attention about fetal movement

a) Fetal movement is rather perception of woman. Busy mother tends to feel less fetal movement.

b) Working in busy environment may cause less perception of fetal movement.

c) Women which is first time pregnant may become to anxious about fetal condition and notice about decrease in fetal movement as compared with multi para.

2) Identification of maternal risk factor which might contribute to perinatal mortality.

- age, smoking, overweight/obesity, previous stillbirth or neonatal death

3) What actually the causes of reduce or absent fetal movement?

a) Placenta Abruptio

b) Intra uterine growth restriction

c) Syndromic baby

d) Placenta insufficiency.

e) Mother’s perception.

4) Investigation to support diagnosis

Management

1) Take full history and elicit risk factor that might compromise fetal condition.

2) Measure symphiso fundal height for screening of IUGR caused by placental insufficiency.

3) Fetal well being assessment (recommended by NICE guideline) non stress test CTG, Ultrasound.

4) Fetal kick chart (not recommended by NICE and others as it will cause more anxiety to the mother.) however, some says it is better than doing nothing.

5) If CTG or ultrasound shows fetal compromise, admit patient to the wards and do serial monitoring of fetal condition

6) Re assures the mother.