The appearance of fetal movement and changes during pregnancy Fetal movement is the movement of the fetus’ trunk or limbs. The fetus can have movement of its limbs as early as 12 weeks of gestation. The fetal movement is usually felt at 18-20 weeks for primiparous women and at 16 weeks for menstruating women. The appearance of fetal movement reflects the fetus’ neuromuscular development to a certain extent. It is normal for some pregnant women to feel fetal movement later due to local factors such as thicker abdominal fat and placenta located in the anterior wall. Many mothers-to-be say that the fetal movement initially feels like a small fish swimming, after which the fetal movement takes different forms such as punching and kicking, trembling and hiccuping, rolling and so on. The fetal movement gradually increases after it appears and reaches the peak of intensity and frequency at about 32 weeks. The fetal movements generally do not decrease significantly in late pregnancy, but there may be some changes in the form. The significance of perceiving fetal movement in late pregnancy In case of intrauterine hypoxia, the fetus will reduce the movement of its limbs to reduce oxygen consumption due to physiological protection mechanism, so fetal movement can be an important signal to indicate the fetus’ well-being in utero. This is especially important after 28 weeks of gestation, when the fetus has the ability to survive outside the uterus, and if the fetal hypoxia is detected in time, the fetus can be saved by timely delivery. According to statistics, about 55% of pregnant women with stillbirths have felt a decrease in fetal movement before diagnosis. How to count fetal movements The clinical routine of whether to count fetal movements varies slightly from country to country. Our clinicians generally recommend that pregnant women count fetal movements for 3 hours or 1 hour every day according to the versions of different textbooks; the Canadian standing rules suggest that pregnant women with high risk factors for fetal hypoxia should count fetal movements from 26-32 weeks, while low-risk pregnant women should count fetal movements at 36-37 weeks or when they feel abnormal fetal movements. The UK standing rule suggests that counting fetal movements may increase maternal anxiety, so it is only recommended that pregnant women sense fetal movements and notice the decrease in fetal movements, but this rule also points out that pregnant women who are busy with other things may therefore underestimate the decrease in fetal movements, and it may make more sense to concentrate on sensing fetal movements (which is still counting fetal movements, haha). So I still recommend that after 28 weeks, pregnant women fix a more convenient time every day to carefully perceive and count the fetal movements. The form and frequency of fetal movement varies from person to person, usually the fetus moves slightly more in the afternoon or evening, the fetus has a 20-40 minute sleep-wake cycle, and it is normal that the fetal movement during the sleep period may be reduced or even absent. Therefore, it is difficult to say that there is an absolute standard of normal fetal movement (this is not even standardized in all countries, haha). The simpler way is to have at least 3 fetal movements in an hour, if the fetal movements do not reach 3 times in an hour, you need to count the next hour, and if it does not reach 6 times in two hours, you should seek medical attention for further judgment. Because of the difference in the frequency of activity of different fetuses, if the cumulative number of fetal movements in two hours does not reach the number of times in one hour of the previous day, it should also be judged as a decrease in fetal movements. As for how to count a fetal movement, it is a somewhat subjective issue, and pregnant women need to know that it is impossible to count all the fetal movements in any case. In a foreign study, where fetal ultrasound was performed while pregnant women were counting fetal movements, it was found that most pregnant women could only perceive about one-third of the actual fetal movements. It is generally believed that any fetal movement should be counted as one, except for continuous fetal movements such as hiccups or tremors, which can be counted as one, not one for 5 minutes or less as some claims suggest. It should also be emphasized that the routine in each country clearly states that pregnant women need to know that when they notice a decrease in fetal movement, they should seek immediate medical attention rather than continuing to wait for a visit the next day. For some high-risk pregnancies, such as intrauterine growth retardation and low amniotic fluid, it may be necessary to increase the number of fetal movements counted daily. Listening to fetal heartbeat is not a substitute for fetal movement counting There are various brands of fetal heartbeat monitors for home use. As a signal of fetal presence that can be perceived by the parents-to-be at the same time, the advent of fetal heartbeat monitors has brought much joy to the parents-to-be. However, fetal heart auscultation is not a substitute for fetal movement counting. This is because the presence of fetal heartbeat can only serve as a signal of instantaneous fetal survival, but cannot indicate the reserve capacity of the fetus in utero (whether it is hypoxic or not). How to count fetal movements in multiple fetuses is indeed a challenge. Twin fetuses are judged from high risk factors and are indications for enhanced intrauterine fetal monitoring. However it is really difficult to achieve monitoring by counting fetal movements. On the one hand, due to the hyperinflation of the uterus by two fetuses and the relative crowding in the uterus, fetal movements change in form and are difficult for the mother to perceive; on the other hand, even if fetal movements can be perceived, it is difficult to clearly determine from which fetus they are coming. (As one of the two children, my mother has repeatedly stressed to me after I was engaged in maternity, my sister and I really did not move at all in her belly, lol) However, it is feasible for a pregnant woman with multiple children to perceive the fetal activity according to her own situation and judge by herself whether there are obvious changes.