Aida Salihagić-Kadić

New scoring system for fetal neurobehavior assessed by three- and four-dimensional sonography

Abstract Aim: To produce a new scoring system for fetal neurobehavior based on prenatal assessment by 3D/4D sonography. We identified severely brain damaged infants and those with optimal neurological findings and compared fetal with neonatal findings. Results: The new scoring system was retrospectively applied in a group of 100 low-risk pregnancies. After delivery, postnatal neurological assessment was performed, and all neonates assessed as normal reached a score between 14 and 20, which we assumed to be a score of optimal neurological development. Subsequently, the same scoring system was applied in the group of 120 high-risk pregnancies in which, based on postnatal neurological findings, three subgroups of newborns were found: normal, mildly or moderately abnormal, and abnormal. Normal neonates had a prenatal score between 14 and 20, mildly or moderately abnormal neonates had a prenatal score of 5–13, whereas those infants who were assigned as neurologically abnormal had a prenatal score from 0–5. Conclusion: A new scoring system for the assessment of neurological status for antenatal application is proposed, similar to the neonatal optimality test of Amiel-Tison. This preliminary work may help in detecting fetal brain and neurodevelopmental alterations due to in utero brain impairment.

The assessment of fetal behavior in early pregnancy: comparison between 2D and 4D sonographic scanning

Abstract Aim: To determine the accuracy of 4D sonography in the assessment of embryonic and early fetal motor activity in the first trimester of normal pregnancy, in comparison to the 2D sonography. Methods: Fifty pregnant women between 6–14 weeks of gestation with singleton pregnancy were assigned for the investigation. Two dimensional and four dimensional recordings were displayed on the screen and recorded on the videotape during the 15 minutes observation period. Results: General body, head and limb movements recorded by 2D sonography were notable by 4D technique in the same gestational age. These movements were presented collectively with maximum, minimum, and median frequencies during 15 minutes observation period. Spearman rank order correlation reached statistical significance (P<0.05) between the frequencies of all observed movement patterns assessed by two different techniques. Several movement patterns, such as sideway bending, hiccup, breathing movements, mouth opening and facial movements could be observed only by 2D sonographic technique in this period of gestation. Conclusion: Presently, both 2D and 4D methods are required for the assessment of early fetal motor development and motor behavior. It is reasonable to expect that such technological improvement may provide some new information about the intrauterine motor activity and facilitate the prenatal detection of some neurological disorders.

Fetal cerebrovascular response to chronic hypoxia—implications for the prevention of brain damage

Fetal hypoxia is one of the leading causes of perinatal morbidity and mortality. One of the most severe sequels of fetal hypoxic insult is the development of perinatal brain lesions resulting in a spectrum of neurological disabilities, from minor cerebral disorders to cerebral palsy. One of the most important fetal adaptive responses to hypoxia is redistribution of blood flow towards the fetal brain, known as the ‘brain sparing effect’. The fetal blood flow redistribution in favor of the fetal brain can be detected and quantified by the Doppler cerebral/umbilical ratio (C/U ratio = cerebral resistance index (CRI)/umbilical resistance index (URI)). Our studies on animal models and human fetuses have demonstrated clearly that this phenomenon cannot prevent the development of perinatal brain lesions in the case of severe or prolonged hypoxia. Fetal deterioration in chronic and severe hypoxia is characterized by the disappearance of the physiological cerebral vascular variability (vasoconstriction and vasodilatation), followed by an increase in cerebral vascular resistance. However, our latest study on growth-restricted and hypoxic human fetuses has shown that perinatal brain lesions can develop even before the loss of cerebrovascular variability. The fetal exposure to hypoxia can be quantified by using a new vascular score, the hypoxia index. This parameter, which takes into account the degree as well as duration of fetal hypoxia, can be calculated by summing the daily % C/U ratio reduction from the cut-off value 1 over the period of observation. According to our results, the use of this parameter, which calculates the cumulative, relative oxygen deficit, could allow for the first time the sensitive and reliable prediction and even prevention of adverse neurological outcome in pregnancies complicated by fetal hypoxia.

The role of 4D sonography in the neurological assessment of early human development

The spectrum of disorders attributable to primary aberrations of the developmental program should increase dramatically in the next decades, in concert with the continuing explosion of neurobiologic insights into normal brain development. Neurological disability is the most feared complication of pregnancy, labor and the neonatal period. The cause and effect relationship is often uncertain. The advent of 4D sonography and its application to study of fetal behavior have begun to provide insight into the structural and functional fetal brain development.

New data about embryonic and fetal neurodevelopment and behavior obtained by 3d and 4d sonography

Abstract The development of the human central nervous system (CNS) begins in the early embryonic period and proceeds through a sequence of very complicated processes long after delivery. Although the neurodevelopmental processes are genetically determined, their complexity and intensity implicates the vulnerability of the CNS to number of environmental factors. There is substantial evidence to show that many neurological problems, from minor cerebral dysfunction to the cerebral palsy, originate form the prenatal, rather than perinatal or postnatal periods of life. A variety of neurological and neuropsychiatric diseases is nowadays considered to originate, at least partly, from the prenatal incidents. In most of these conditions, there is no reliable parameter for detection or prediction of cerebral lesions and there is an urgent need to develop strategies that would enable the early detection of cerebral lesions or indications that such lesions might occur. The new, advanced, imaging techniques such as 3-dimensional and 4-dimensional sonography, opened a new perspective for the investigation of structural and functional development of fetal CNS. The application of these techniques might improve our understanding of the prenatal neurodevelopmental events and possibly facilitate the development of diagnostic strategies for early detection or prevention of brain dysfunctions and damage.

New Doppler index for prediction of perinatal brain damage in growth‐restricted and hypoxic fetuses

To evaluate the new vascular score, hypoxia index (HI), in the prediction of sonographically detected structural brain lesions in neonates within the first week after delivery of growth‐restricted fetuses.

Neurobehavior in fetal life

Assessment fetal behavior gave a promising opportunity to understand the hidden function of the developmental pathway of the fetal central nervous system. After the assessment of normal neurobehavioral development by four-dimensional (4D) ultrasound, attempts have been made to identify functional characteristics of the fetus that predict a range of subsequent developmental dysfunction. These attempts resulted in producing the Kurjak Antenatal Neurodevelopmental Test (KANET). Assessment of fetal behavior by 4D ultrasound and application of KANET scoring test has been recently published in several journals and summarized results are presented in this review.

Neurophysiology of fetal behavior

During recent decades, the development of ultrasonic techniques has enabled the direct visualization of fetal life in utero. Real-time recording of fetal activity in various periods of gestation and the analysis of behavioral patterns have resulted in the detailed description of sequential changes in fetal behavior and provided information about the functional development of the fetal central nervous system. It is generally accepted that patterns of fetal activity reflect the development and maturation of the central nervous system. Therefore, the distinction between normal and abnormal fetal behavior could make possible the detection of discrete structural brain abnormalities. Fetal behavioral patterns throughout gestation and their correlation with structural developmental events are discussed in this review.

Four-dimensional sonography in the assessment of fetal functional neurodevelopment and behavioral patterns

AbstractDuring the past few decades, morphological studies of fetal brains as well as ultrasonic imaging of fetal intrauterine activities in real time have provided invaluable information about the most important events in the development of human central nervous system. It has been shown that development of fetal brain proceeds through a sequence of complicated histogenetic processes, which are reflected in the fetal behavioral patterns. Major developmental events, such as the establishment of neural connections in different regions of the brain, are accompanied by the occurrence of new patterns of fetal activities or by the transformation of existing patterns. It has been suggested that the ultrasound assessment of fetal behavior could be used for the evaluation of the integrity of fetal central nervous system and, possibly, for the detection of functional or structural brain disorders. The new, advanced imaging techniques such as four-dimensional sonography might open a new perspective for the study of...