Decreased fetal movements — structured oral station (12 minutes)

Opening prompt — "Tell me what you do from the doorway."

Model response — say it in this order: ^[1][3]

• "I would confirm fetal viability at the bedside with a handheld Doppler or ultrasound, take a focused history of the change in movements and any associated symptoms, and run a 20-minute CTG."
• "While that is happening I would observe whether the baby is moving during the assessment, examine the abdomen for fundal height and tenderness, and check her observations to exclude pre-eclampsia or sepsis."
• "I would reassure her that she did the right thing by coming in — reduced movement is something we always take seriously."

Examiner is listening for: viability confirmed first, the CTG plus the broader assessment, and explicit validation of the woman's presentation. ^[3]

Probe 1 — "Her CTG is reactive and the baby is moving. The midwife says she is fine and can go home. What do you do?"

• "A reactive CTG is reassuring for the next twenty minutes, but it does not exclude fetal growth restriction or a failing placenta — the CTG tells me about the next minutes, growth and Doppler tell me about the next weeks."^[3][5]
• "Her last growth scan was at 32 weeks, so I would arrange an ultrasound for fetal biometry on customised charts, amniotic fluid volume, and umbilical artery Doppler before deciding on discharge."
• "I would also ask about her smoking and counsel her on smoking cessation, because smoking carries an adjusted odds ratio of 2.96 for adverse outcome after reduced fetal movements."^[2]

Probe 2 — "She asks whether it is normal for the baby to slow down at the end. What do you say?"

• "I would be honest: the vigour of movement may change as the baby runs out of room, but the frequency of movements should not decrease. A reduction in frequency is not normal, and that is why we assess every woman who presents."^[1]
• "I would not say 'it's normal at term' — that dismissal is a recurring theme in stillbirth reviews."
• "I would give her written information about normal fetal movements and the Safer Baby Bundle advice, including side-sleeping in the third trimester."^[6]

Probe 3 — "Two days later she re-presents with the same complaint. How does your management change?"

• "Recurrent DFM up-tiers the risk. The Lu IPD meta-analysis shows recurrent reduced movements cluster with fetal growth restriction and placental insufficiency."^[2]
• "I would involve the senior obstetrician, repeat the full assessment including growth and Doppler, and have a discussion with her about induction of labour or planned birth. A third presentation would be a near-mandate for a senior decision about birth."^[2]

Probe 4 — "What does the evidence say about raising awareness of fetal movements to reduce stillbirth?"

• "The AFFIRM trial, a stepped-wedge cluster randomised trial in the UK and Ireland with over 400 000 pregnancies, did NOT reduce stillbirth — 4.40 versus 4.06 per 1000, adjusted odds ratio 0.90, 95% CI 0.75 to 1.07."^[4]
• "The My Baby's Movements trial in Australia and New Zealand gave a similar result, and actually showed more induction of labour and early-term birth in the intervention group."
• "But the individual-level association is real — the Thompson IPD meta-analysis shows reduced frequency carries an adjusted odds ratio of 2.33 for late stillbirth. So the right response to an individual woman is assessment, not dismissal."

Probe 5 — "She is frightened and her partner is anxious. Talk me through your communication."

This is a scored domain, not a courtesy. Demonstrate it out loud: ^[6]

• Move to her eye level, use her name, validate her: "You were absolutely right to come in. We always take a change in your baby's movements seriously."
• Explain findings in plain language: "The heart-rate trace is reassuring for now. I want to do a scan to check your baby's growth and the blood flow, because that tells us about the next few weeks, not just today."
• Give a clear plan and a written safety-net: "If you notice another change, come straight back — you will never be wasting our time."