What Care Should I Expect After 28 Weeks Pregnant When Reporting Reduced Movements? 

After 28 weeks, fetal movements are expected to be regular and well-established.
From this point, reduced movements are a clinically significant event, and care is more structured and consistent across the NHS.

1. Immediate Triage - Same Day Assessment

You should be told to attend straight away and be seen promptly.


Staff will take a detailed history including:

  • Time and pattern of movement change

  • Any bleeding, pain, fluid loss, contractions

  • Infection symptoms

  • Any risk factors (e.g., growth concerns, hypertension)

  • Whether this is a first or recurrent episode

 2. Maternal Observations (vital signs)

This is a standard requirement.

They should have:

  • Blood pressure

  • Pulse

  • Temperature

  • Respiratory rate

  • Urine dip (infection, protein, ketones)

  • Assessment of pain or tenderness

These are recorded using a MEOWS chart (Maternity Early Obstetric Warning Score).

3. Confirming the fetal heartbeat

A midwife will check the heartbeat with a handheld Doppler before any CTG is started.

 4. CTG monitoring (Cardiotocography)

This is standard of care after 28 weeks.

Expect:

  • A 20–30 minute CTG

  • Assessment of baseline heart rate, variability, accelerations and decelerations

CTG should be reviewed by a trained midwife and signed off by an obstetric registrar or consultant if there are concerns.

 5. Ultrasound Scan if Needed

If the CTG is not clearly reassuring, or if there are risk factors, or if this is a recurring episode, an ultrasound should be offered.

The scan will usually check:

  • Fetal growth (estimated weight)

  • Amniotic fluid volume

  • Umbilical artery Dopplers

  • Placental appearance/function

If a scan cannot be done immediately (e.g., out of hours), many hospitals offer:

  • CTG + review today

  • Urgent scan by the next day

No one should be told to wait until a routine appointment.

 6. Clear Safety-Netting Before Discharge

Whether monitoring is normal or not, they should receive:

  • Instructions to return immediately if movements reduce again

  • 24/7 triage contact details

  • Reassurance they can come back as many times as they need

They should never be told:

  • “You’ve already been in this week, try not to come back”

  • “It’s normal for movements to slow down as the baby gets bigger” (this is incorrect)

  • “Your placenta is anterior so you won’t feel much”

  • “Just drink something cold and lie down” (not evidence-based care)

 7. Additional reviews if concerns persist

Depending on findings:

  • Obstetric review

  • Repeat CTG

  • Repeat scan

  • Growth surveillance pathway

  • Blood tests if infection/preeclampsia suspected

  • Steroids/monitoring if preterm birth risk identified

8. Recurrent Reduced Movements

If someone has more than one episode of reduced movements after 28 weeks, RCOG states:
They should receive:

  • Consultant-led review

  • Growth scan and Dopplers

  • Consideration of induction or closer monitoring depending on findings and gestation