Standard Kick Chart Formulas

4/4 Time - Basic Rock/Pop

Beat:  1 . . . 2 . . . 3 . . . 4 . . .
Kick:  X . . . . . . . X . . . . . . .

4/4 Time - Four-on-the-Floor (Dance/EDM)

Beat:  1 . . . 2 . . . 3 . . . 4 . . .
Kick:  X . . . X . . . X . . . X . . .

Hip-Hop / Trap Pattern

Beat:  1 e + a 2 e + a 3 e + a 4 e + a
Kick:  X . . . . . X . X . . . . . . .

Kick Chart Formula (General Rule)

Kick = Downbeat anchor + syncopation offset

• Drumming / percussion chart (notation for a specific genre)
• Kick boxing / martial arts scoring chart
• Kick (slang for shoe) sizing/release chart
• Kick in film production (camera movement formula)
• Financial/sales kick chart (incentive formula)

KICK Chart - Fetal Movement Counting (FMC)

What is the KICK Chart?

A hypoxic fetus reduces its oxygen consumption by decreasing its activity - so reduced fetal movement is an early warning sign of fetal compromise.

Three Main Methods (Know All Three!)

Cardiff Count-to-Ten Formula (The Classic KICK Chart)

1. Start counting in the evening (when fetus is most active)
2. Count every fetal movement - kicks, rolls, swishes, jabs
3. Record the time when the 10th movement is felt
4. Usually completed within 20 minutes

Reassuring  = 10 movements counted in < 2 hours ✓
Non-reassuring = < 10 movements in 2 hours ✗ → Refer immediately

When to Start?

• High-risk pregnancies: Begin at 28 weeks gestation (diabetes, hypertension, previous stillbirth, FGR)
• Previous stillbirth: Start kick counts at 28 weeks + NST twice weekly from 32 weeks
• Low-risk pregnancies: No strong evidence for routine daily FMC in all pregnancies

Clinical Decision Tree

Patient reports decreased fetal movement
            ↓
Perform kick count (Cardiff method)
            ↓
     < 10 kicks in 2 hrs?
      /              \
    YES               NO
     ↓                 ↓
Refer to L&D        Reassure, continue
for NST/BPP         daily monitoring

Important Clinical Points to Remember in Your Posting

Fetal Movements to Count

• Kicks
• Rolls
• Swishes
• Jabs
• Hiccups (some debate - often NOT counted)

Red Flags - Go to Labour and Delivery Immediately

• Fewer than 10 movements in 2 hours during active time
• Sudden cessation of fetal movement after a previously active pattern
• Any period of no movement for > 12 hours

Evidence Summary (From Creasy & Resnik's Maternal-Fetal Medicine)

• Decreased fetal movement is associated with stillbirth, but evidence that kick counting prevents stillbirth is controversial
• A large RCT did not demonstrate a reduction in stillbirth rates with fetal movement awareness programs, but noted an increase in interventions (inductions, hospital admissions)
• Current consensus: insufficient data to make firm recommendations on routine kick counting, but it remains standard practice in high-risk pregnancies

• Pfenninger & Fowler's Procedures for Primary Care, p. 1150 - Cardiff method technique
• Creasy & Resnik's Maternal-Fetal Medicine, p. 1011-1012 - Evidence and management

Cardiff "Count-to-Ten" Method - Complete Clinical Guide

Physiological Basis

A hypoxic fetus reduces its oxygen demand by decreasing activity. Therefore, reduced fetal movement = potential fetal compromise.

• Pfenninger & Fowler's Procedures for Primary Care, p. 1149

The Cardiff Technique - Step by Step

Patient Instructions (What You Tell the Mother)

• Perform the count in the evening (fetus is most active after meals and at night)
• Lie in the left lateral decubitus position (left side) - improves uteroplacental blood flow
• Can also sit in a comfortable, reclining position
• Place one hand on the abdomen to help feel movements

• Note the exact start time
• Begin counting every fetal movement felt: kicks, rolls, swishes, jabs, flutters

• Count every movement as one
• Stop when 10 movements are felt
• Record the time of the 10th movement

• Duration = Time of 10th movement - Start time
• Most healthy fetuses reach 10 movements within 20 minutes
• Maximum normal time = 2 hours

Interpreting the Result

Comparison of the Three FMC Methods

• Pfenninger & Fowler's Procedures for Primary Care, p. 1150

Contraindications to Cardiff FMC

1. Impaired mental status - patient cannot reliably report movements
2. Language/cultural barriers - cannot understand instructions properly
3. Mother unable to sense fetal movements - even when movements are visible clinically (e.g., during fundal height measurement), the mother may not perceive them

Complications / Limitations

• High false-positive rate - a non-reassuring FMC does not always mean fetal distress
• False-positive results cascade into:
  • Unnecessary hospital admissions
  • False-positive NST/BPP results
  • Unnecessary induction of labor - exposing mother and baby to risks of induction
• Largest RCT (Grant et al., 1989; n = 68,000): routine FMC in low-risk pregnancies did not improve perinatal outcomes

What Happens After a Non-Reassuring Result?

Non-reassuring Cardiff count (< 10 in 2 hrs)
              ↓
     Report to Labour & Delivery
              ↓
     NST (Nonstress Test) - FIRST LINE
              ↓
   Reactive NST → Reassure & continue FMC
              ↓
Non-reactive NST → BPP or CST (Contraction Stress Test)

NST Criteria (for context in your posting)

• Reactive (reassuring): 2 or more fetal heart rate accelerations of ≥15 bpm lasting ≥15 seconds within a 20-minute window (at ≥ 32 weeks)
• Before 32 weeks: accelerations of ≥10 bpm lasting ≥10 seconds

Factors That Reduce Fetal Movement (Mimics / Confounders)

Clinical Pearl for Your Posting

1. Ask - when did she last feel movement, how many today
2. Do Cardiff count at bedside (semi-reclined, left lateral tilt)
3. If non-reassuring → attach CTG/NST monitor immediately
4. Check AFI (amniotic fluid index) by ultrasound if NST is non-reactive
5. Consider BPP scoring (max 10 points - 2 points each for tone, movement, breathing, AFV, NST)