We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.
You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits.
To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:
On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.
On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.
Please get in touch with ann.wales3@nhs.scot with any questions.
09/08/19 Update - addition of umbilical artery Doppler to any scan
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Maternal perception of fetal movement is one of the first signs of fetal life and is regarded as a manifestation of fetal wellbeing. Fetal movements have been defined as any discrete kick, flutter, swish or roll. A significant reduction or sudden alteration in fetal movement is a potentially important clinical sign. It has been suggested that reduced or absent fetal movements may be a warning sign of impending fetal death. Studies of fetal physiology using ultrasound have demonstrated an association between RFM and poor perinatal outcome.
Clinicians should be aware (and should advise women) that although fetal movements tend to plateau at 32 weeks gestation, there is no reduction in the frequency of movements in the late third trimester.
Women who have normal clinical assessment and investigations after first episode of RFM should be advised to contact the maternity unit if they have a further episode.
Women who have normal clinical assessment and investigations after second (or more) episode of RFM should undergo a scan (including umbilical artery Doppler) for fetal well being (unless they have had a normal scan within 3 weeks). At the third presentation, the woman should be referred to the consultant-led antenatal clinic for consideration of increased fetal surveillance.
Those women who are still not feeling fetal movements after having a normal scan and CTG should be offered either daily CTGs as an outpatient or admission and twice daily CTGs until movements return.
Women who present on two or more occasions with RFM are at increased risk of a poor perinatal outcome. There are no studies to determine whether intervention (e.g. delivery or further investigation) alters perinatal morbidity or mortality. The decision whether or not to induce labour at term in a woman who presents recurrently with RFM when the growth, liquor volume and CTG appear normal must be made after careful consultantled counselling of the pros and cons of induction on an individualized basis (RCOG Green Top Guideline No. 57)
If a woman presents with RFM between 24+0 and 27+6 weeks of gestation, the presence of a fetal heartbeat should be confirmed by auscultation with a Doppler handheld device.
The fetal heartbeat should be confirmed to check fetal viability. History must include a comprehensive stillbirth risk evaluation, including a review of the presence of other risk factors associated with an increased risk of stillbirth. Clinicians should be aware that placental insufficiency may present at this gestation. A complete antenatal assessment including measurement of fundal height, BP and urine should be carried out. If there is clinical suspicion of FGR, or raised BP/proteinuria consideration should be given to the need for ultrasound assessment. There is no evidence on which to recommend the routine use of ultrasound assessment in this group.
If a woman presents with RFM before 24+0 weeks of gestation, the presence of a fetal heartbeat should be confirmed by auscultation with a Doppler handheld device.
A full antenatal check-up must also be completed including measurement of fundal height, BP and urine.
If fetal movements have never been felt before 24 weeks, a referral should be made to a medical sonographer to exclude any neuromuscular conditions.
Reduced fetal movements at ≥ 28+0 weeks assessment form (pdf)