Deadly Warning of Fetal Motion Disappearing at 38 Weeks｜International Center for Perinatal Medicine
Lancet 2025: Placental abruption responsible for 20% of stillbirths globally, underdiagnosis of preeclampsia tops list of culprits
I.Scarlet Dawn: 72 hours of life and death for a 29-year-old pregnant woman in Madrid
Sophia Martínez (pseudonym), G1P0 at 38 weeks gestation, kept a pregnancy diary recording the abnormal trajectory:
Day 1: sudden onset of tearing pain in the lower abdomen accompanied by shivering, with a sharp decrease in fetal movement by 80%
Day 3: “improved” after self-administration of paracetamol, with a complete disappearance of fetal movement
Day 5: emergency blood pressure of 140/100mmHg, with ultrasound confirmation of fetal heart stoppage
Cesarean section shocked the truth:
Placental abruption >50% (bluish-purple ecchymosis spreading on uterine wall)
Bloody amniotic fluid coagulation clot (total 800ml)
Uterine Stroke Index Score of 9 (severe)
Dr. Carlos Rivera, Madrid Emergency Obstetrics Unit, warns, “Abnormal fetal movement is the last distress signal of the fetus, and for every hour delay in consulting the doctor, the risk of stillbirth rises by 11%!”
II. Placental abruption: a bloody storm hidden in the uterine cavity
Pathologic nature: chain reaction of collapse of the meconium vasculature
Spasticity of spiral arteries –> hemorrhage of the underlying meconium –> formation of a retroplacental hematoma –> enlargement of the placental abruption surface –> blood infiltration of the myometrium –> uteroplacental stroke
Global Risk Factor Mapping
| risk level | Core factors | Relative risk (RR) |
|---|---|---|
| extremely high risk | pre-eclampsia | 8.2 |
| high risk | Abdominal trauma/excessive amniotic fluid | 4.7 |
| critical | Smoke inhalation > 10 sticks/day | 3.1 |
| low risk | Advanced age (≥35 years)/multiple births (≥3) | 1.8 |
III. Preeclampsia: The Neglected Invisible Killer (Sophia’s True Etiology)
Hidden trajectory of progression:
12 weeks gestation: fasting glucose 6.8 mmol/L (no intervention)
28 weeks gestation: blood pressure fluctuating 130-140/85 mmHg (no monitoring)
38 weeks gestation: urine protein 0.86g/24h + platelets 85×10³/μl
Three fatal lapses:
Glucose indulgence: no OGTT to confirm diagnosis of gestational diabetes
Blood pressure omission: no ambulatory monitoring in 4 labor and delivery tests
Symptom misdiagnosis: chills + abdominal pain misdiagnosed as gastroenteritis
New FIGO 2025 criteria: eclampsia diagnosed after 20 weeks of gestation when any two of the following are present
Pre-eclampsia:
Systolic blood pressure ≥140 or diastolic blood pressure ≥90 mmHg
Urine protein ≥0.3g/24h
Platelets <100×10³/μl or elevated liver enzymes
IV.Fetal movement monitoring: the ultimate code of fetal safety and security
▶ Fetal movement alarm gold standard
Cambridge Fetal Movement Counting Method: Perceived <10 kicks within 2 hours in left lateral position
Upgraded monitoring for high-risk groups:
Pre-eclampsia: 1 count per day in the morning and 1 count per day in the evening
Diabetes mellitus: Combined Fetal Heart Monitor
▶ Key points for symptom screening
| symptom (of a disease) | Cold misdiagnosis rate | Placental abruption-specific manifestations |
|---|---|---|
| tremble | 85% | No fever + progressive abdominal pain |
| nausea and vomiting | 92% | Vomiting without bile + elevated uterine fundus |
| fatigue and drowsiness | 78% | Sudden decrease in fetal movement >50% |
V. Cruel Limitations of Ultrasound Diagnosis and the Way to Break the Situation
1. Blind spots of traditional ultrasound
Sensitivity is only 25%: cannot recognize a retroplacental hematoma when it has not formed
False-negative area: borderline abruption/chronic preterm abruption
2. Cutting-edge technology to solve the problem
Vector Flow Imaging (VFI): detection of spiral artery flow interruption (sensitivity increased to 91%)
Elastic ultrasound: quantification of placental hardness (elasticity value >35kPa in the region of premature abruption)
AI-assisted diagnosis: deep learning to recognize placental “crater sign”.
Uteroplacental stroke: a nightmare moment for obstetricians
ralph lauren polo ralph lauren pathology grading and decision tree
| separate into different kinds | Uterine performance | treatment program |
|---|---|---|
| mildly | Focal blue violet spot <5cm | Hot saline gauze compression + prostaglandin |
| moderately | Petechiae covering 1/3 of the uterus | B-Lynch suture + blood transfusion support |
| severe | Total uterine plasma layer infiltration | Uterine artery embolization + hysterectomy |
Sophia’s Resuscitation
1. 750 ml of red blood cell suspension + 600 ml of cold precipitate were infused.
2. Platelet infusion to make the count >80×10³/μl.
3. intraoperative cesarean section with uterine massage + 20U of hysterotonin in the uterus
4. Abdominal incision pressure sandbag to prevent hematoma
The latest international treatment guidelines: from early warning to surgery
1. Early warning system upgrade
Pre-eclampsia screening kit: PLGF+sFlt-1 at 11-13 weeks of pregnancy (95% detection rate)
Fetal movement smart monitor: automatic counting by wearable device + early warning of abnormality
2. Decision-making matrix for termination of pregnancy
if fetus survives:
immediate cesarean section (within 30 minutes)
elif intrauterine fetal death + poor cervical condition:
blood transfusion to correct coagulation → emergency cesarean section
elif intrauterine fetal death + cervical ripening:
induction of labor (to avoid risk of uterine rupture)
3. Four-step uterine resuscitation
Hysterectomy 40U IV –> Prostaglandin F2α uterine injection –> C[B-Lynch suture –> Uterine artery ligation –> Interventional embolization
VIII. Lessons in Blood: The Laws of Survival for Pregnant Women Worldwide
Fetal movement is a barometer of life:
Daily counts in left lateral position from 28 weeks of pregnancy
Immediate emergency care for <10 counts in 2 hours
Blood pressure monitoring is not to be compromised:
Home measurements 3 times a week for those at risk
Same day consultation for systolic blood pressure >140 mmHg
Red alert for abdominal pain:
Lasts >30 minutes with hard abdomen
Nausea and vomiting without diarrhea
Dr. Emma Wilson, President of the World Society of Perinatology, says: “Every movement is a declaration of the heartbeat of the fetus, and the cost of ignoring it can be eternal pain!