Mrs Eze woke at 34 weeks and realised she hadn't felt her baby move all morning. Six hours of stillness in a baby who normally kicked her awake. The Doppler scan at Mascot Healthcare took 20 minutes — blood flow in the umbilical cord, the baby's brain, and the placenta were all normal. The baby moved during the scan.
Accountant, Gbagada. Third pregnancy (two previous normal deliveries). Presented at 34 weeks 3 days with reduced fetal movements — had not felt baby move all morning (approximately 6 hours). No abdominal pain, no bleeding, no fluid loss. CTG on arrival: reactive. Referred for Doppler scan.
Obstetric Doppler ScanMrs Eze's third baby had been consistently active throughout the pregnancy — she joked that this one "never slept." At 34 weeks, she woke at 6 AM and waited for the usual morning kicks. Nothing. She had tea, lay on her side (the position that usually prompted movement), waited again. Nothing. By noon, she was at Mascot Healthcare.
A CTG (cardiotocograph) trace was done immediately — the fetal heart rate pattern was reactive (normal), with the characteristic accelerations that indicate fetal wellbeing. But a reactive CTG is a snapshot; it does not assess placental blood flow. A Doppler scan was requested to assess the umbilical artery and fetal cerebral circulation.
During the Doppler scan, the sonographer placed the probe on Mrs Eze's abdomen. The umbilical artery waveform appeared on screen — the characteristic sawtooth pattern of normal flow. "The flow in the cord is normal," the sonographer said. At that moment, the baby stretched. Mrs Eze felt it and exhaled audibly.
Reduced fetal movement is one of the most important warning signs in late pregnancy. While most cases are reassuring on assessment, a significant proportion of unexplained stillbirths follow periods of reduced fetal movement that were not investigated. Assessment — including a Doppler scan — is always the right response.
No perceived fetal movement for approximately 6 hours in a baby whose normal pattern was strong regular kicks — a significant change from baseline.
A viable gestation where fetal wellbeing assessment has immediate clinical implications — delivery is an option if compromise is detected.
Experienced mother — knows what normal fetal movement feels like for her; the change from normal was notable and accurate.
The baby had been particularly active the previous night — making the prolonged morning stillness more notable.
Mrs Eze was visibly distressed on arrival — appropriate maternal concern that warranted immediate assessment.
Mrs Eze had read about stillbirth. She knew that reduced movement was a warning sign. By the time she arrived at Mascot Healthcare, she was composing mental sentences she hoped she would never have to say. "I was preparing myself for the worst," she said afterwards.
The CTG result provided the first reassurance. The Doppler scan provided the second — and definitive — reassurance. Understanding what Doppler measures helped: the umbilical artery Doppler assesses blood flow from placenta to baby; the middle cerebral artery Doppler assesses fetal brain circulation; normal waveforms in both indicate the baby is not under haemodynamic stress.
Umbilical artery Doppler: normal flow velocity waveform; S/D ratio 2.8 (normal for 34 weeks); absent or reversed end-diastolic flow: no — end-diastolic flow present and normal. Middle cerebral artery (MCA) Doppler: PSV 44 cm/s (normal for gestational age; elevated MCA PSV would suggest fetal anaemia). Brain-sparing ratio (MCA PI/UA PI): 1.6 — normal, no evidence of brain-sparing redistribution.
Biophysical profile (BPP): fetal breathing movements present; gross body movement present (baby moved twice during scan); tone present; amniotic fluid normal (AFI 12 cm); CTG reactive. BPP score: 8/8 — normal.
Presentation: cephalic. Placenta: anterior, grade 2, no retroplacental haematoma. Estimated fetal weight: 2.24 kg — 48th centile for 34 weeks.
Umbilical artery Doppler: normal. MCA Doppler: normal. BPP 8/8. EFW 2.24 kg (48th centile). AFI 12 cm. No evidence of fetal compromise.
Discharge home with fetal movement monitoring instruction (kick count chart); return immediately if movement reduces again; repeat growth scan in 2 weeks; antenatal team informed of attendance.
Growth scan at 36 weeks: biometry on centile, Doppler normal. Delivered at 39 weeks — baby boy, birth weight 3.1 kg, Apgar 9/10.
Mrs Eze delivered a healthy baby boy at 39 weeks. The fetal movement episode at 34 weeks was likely physiological quiet period — confirmed benign by the Doppler scan. She says the 20-minute scan was "the most important 20 minutes of my pregnancy."
Reduced fetal movement is always worth checking — same day. The Doppler scan assesses placental blood flow and fetal haemodynamic status directly, giving information that neither the mother's perception nor the CTG alone can provide.
The majority of reduced fetal movement episodes are reassuring on assessment — but the ones that are not can be life-saving to detect. The decision to come in is always the right one.
Baby moving less? Come in the same day. A Doppler scan takes 20 minutes and tells you exactly how the placenta and baby's circulation are working.
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