A reduction of fetal movements causes concern and anxiety, both for the mother and obstetrician. Reduced fetal movement is difficult to interpret because it is a subjective complaint by the mother...
It has not been well defined in literature, and in most practice settings, there are no clear guidelines as to how the patient and fetus should be assessed. The numerous reasons for reduced movements (physiological, pathological, and occasionally iatrogenic) make it important to interpret the complaint accurately and choose judiciously from the plethora of investigations available to assess fetal wellbeing. This will avoid unnecessary investigations of otherwise uncomplicated pregnancies and the resulting maternal anxiety, inconvenience, and increased obstetric intervention that carries a risk.
As stated earlier, the perception of fetal movements by the mother is highly subjective. Fetal movements follow a circadian pattern and are an expression of fetal wellbeing. Mothers usually report fetal movements from about 20 weeks of gestation, with a peak at 28–34 weeks. Multiparous women may notice movements earlier (16– 20 weeks) than primiparous women (20–22 weeks) 1. It has been suggested that a gradual decline during the third trimester is due to improved fetal coordination and reduced amniotic fluid volume, coupled with increased fetal size. Some ultrasound studies on fetal behaviour show that fetal movements do not become less frequent in the third trimester but that the movements change as coordination improves and a cycle becomes established.
Decreased fetal movements affect 5–15% of pregnancies 2. A number of conditions are associated with reduced fetal movements. The one of primary concern is the fetus affected by hypoxia. Decreased fetal movements are regarded as a marker for suboptimal intrauterine conditions. The fetus responds to chronic hypoxia by conserving energy and the subsequent reduction of fetal movements is an adaptive mechanism to reduce oxygen consumption. A number of 11–29% of women presenting with reduced fetal movements carry a small for gestational age (SGA) fetus below the 10th centile 2,3.
Fetal movements in a healthy fetus vary from 4 to 100 per hour. Maternal perception of fetal movements ranges from 4 to 94% of actual movements seen on concurrent ultrasound scanning 4. There is little agreement among obstetricians on the definition of reduced fetal movements. There is no evidence that any formal definition of reduced fetal movements is ofgreater value than subjective maternal perception in the detection of fetal compromise. Therefore, maternal perception of reduction or change of fetal movements should be considered clinically important.
On 27th April 1877 a male child was born in the family of Vaids which practiced Aurvedic Medicine for generations. This child was Nilkanth Anand Purandare.
As a child he was very curious about diseases and their treatment showing an early aptitude towards learning. Thus he opted for medicine after passing matriculation.
He joined Grant Medical College in 1896 and graduated in 1900. During his studentship he received many prizes and medals and the important one was Charles Morehead prize in Medicine. With this scholarship he was appointed as an Hon. Asst. Obstetrician and Gynaecologist at Bai Motlibai and Petit Hospitals and Tutorship at the Grant Medical College while pursuing his post graduation studies. He passed his M.D. in Obstetrics and Gynaecology with distinction.
In 1911 Dr. N. A. Purandare started his private practice. He knew that obstetric care was exclusively in the hands of ‘dais’. With his kindness, sympathy and brilliance he could break the strong hold of ‘dais’ in obstetric care. Meantime his popularity increased. He became a famous Obstetrician not only in Mumbai and India, but world over.
A few brilliant, dedicated Indian doctors started a hospital and medical college in Parel, Mumbai. They invited Dr. N.A. Purandare to join them. Thus in the year 1926, Dr. N.A. Purandare became Hon. Professor in Midwifery and Gynaecology at the Sheth G.S. Medical College and Hon. Obstetrician and Gynaecologist at the King Edward Memorial (KEM) Hospital. Later he was appointed as Hon. Obstetrician at the Nowrosjee Wadia Maternity Hospital which was across KEM Hospital.
The presence of epithelial cells in the peritoneal cavity and within the myometrium was described during the second part of the 19th century and was given the name “adenomyoma”. Then, with the identification of peritoneal endometriosis in the 1920s, adenomyosis became a separate nosological entity. For decades, the two abnormalities have been considered separate benign proliferative conditions of the female reproductive tract with a different clinical profile. More recently, however, evidence has been accumulated indicating that these two diseases have in common an endometrial dysfunction involving both eutopic and heterotopic endometrium causing a reaction in the inner myometrium (the so-called myometrium junctional zone (JZ)). It therefore seems that adenomyosis and endometriosis share a common origin in an abnormal eutopic endometrium and myometrium JZ. It is therefore no surprise that both conditions are associated with obstetrical disorders, such as spontaneous preterm delivery and premature preterm rupture of the membranes, which may have roots in a disturbed decidualization and placentation process.
endometriosis, adenomyosis, junctional zone myometrium, deep placentation