Oliver Vasilj

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 potential of 4D sonography in the assessment of fetal neurobehavior - multicentric study in high-risk pregnancies

Abstract Objective: An evolving challenge for obstetrician is to better define normal and abnormal fetal neurological function in utero in order to better predict antenatally which fetuses are at risk for adverse neurological outcome. Patients and methods: Prenatal neurological assessment in high-risk fetuses using four-dimensional ultrasound applying the recently developed Kurjak antenatal neurodevelopmental test (KANET). Postnatal neurological assessment was performed using Amiel Tisons neurological assessment at term (ATNAT) for all live-borns and general movement (GM) assessment for those with borderline and abnormal ATNAT. Results: Inclusion criteria were met by 288 pregnant women in four centers of whom 266 gave birth to a live-born baby. It was revealed that 234 fetuses were neurologically normal, 7 abnormal and 25 borderline. Out of 7 abnormal fetuses ATNAT was borderline in 5 and abnormal in 2, whereas GM assessment was abnormal in 5 and definitely abnormal in 2. Out of 25 KANET borderline fetuses, ATNAT was normal in 7, borderline in 17 and abnormal in 1, whereas the GM assessment was as follows: normal optimal in 4, normal suboptimal in 20, and abnormal in 1. In summary, out of 32 borderline and abnormal fetuses ATNAT was normal in 7, borderline in 22 and abnormal in 3; GM assessment was normal optimal in 4, normal suboptimal in 20, abnormal in 6 and definitely abnormal in 2. Conclusion: The sonographic test requires further studies before being recommended for wider clinical practice.

The comparison of fetal behavior in high risk and normal pregnancies assessed by four dimensional ultrasound.

Objective. We compared fetal behavior (FB) in high risk and normal pregnancies using four dimensional ultrasound (4DUS). Methods. For assessment of FB in high risk and normal pregnancies, we used a scoring system of Kurjaks antenatal neurological test (KANET). The newborns were assessed by a postnatal neurological test, Amiel-Tison neurological assessment at term (ATNAT). The scores of KANET in high risk (N = 116) and in normal pregnancies (N = 110) were compared. After delivery, the results of KANET from both groups were compared with ATNAT test. Results. There was a statistically significant difference between group of high risk and normal pregnancies, for 8 out of 10 parameters in KANET: isolated anteflection of the head, eye blinking, facial expressions, mouth movements, isolated hand movement, hand to face movement, fist and finger movements, general movements. There was no difference for cranial sutures and isolated leg movements. Comparison of KANET and ATNAT showed statistically significant, moderate correlation between the two tests, which means that the neuropediatric exam (ATNAT) confirmed the prenatal 4DUS finding (KANET). Conclusion. The difference of FB between the high risk and normal pregnancies was evident. These preliminary results are promising but further studies have to be done before the test could be recommended for wider clinical practice.

Is sonographic assessment of cervical length better than digital examination in screening for preterm delivery in a low-risk population?

Background. This randomized controlled trial compared the diagnostic accuracy of the sonographic assessment of cervical length and clinical digital examination of the cervix in the second trimester regarding the prediction of preterm delivery in a low‐risk population. Methods. In total, 282 unselected, asymptomatic women with singleton pregnancy randomly underwent sonographic cervical length measurement (study group, n = 138) or clinical digital examination (control group, n = 144) in the second trimester. In the study group cervical length ≤5th percentile (≤24 mm) for our population was defined as shortened. In the control group, Bishop score ≥95th percentile (≥4) for our population was defined as high. The primary outcome measure was the diagnostic accuracy of both tests regarding the prediction of preterm delivery (<37 weeks). Results. Shortened cervical length was found in 6/138 (4.3%) women whereas the high Bishop score was found in 17/144 (11.8%) (p = 0.038, Fishers exact test). The incidence of preterm delivery was 5.7% (16/282). Regarding the prediction of preterm delivery, shortened cervical length and high Bishop score had sensitivity 57.1% versus 33.3% and positive predictive value 66.7% versus 17.6%. Shortened cervical length in comparison with high Bishop score had 12‐fold higher positive likelihood ratio for preterm delivery in a low‐risk population (37.4; 95%CI [8.2–170.7] versus 3.2; 95%CI [1.1–9.2]). Conclusion. Sonographic assessment of cervical length has better diagnostic accuracy in the prediction of preterm delivery compared to digital examination in a low‐risk population.

Prenatal and postnatal neurological evaluation of a fetus and newborn from pregnancy complicated with IUGR and fetal hypoxemia

In this case report, we present prenatal and postnatal neurological evaluation of a fetus and newborn from pregnancy complicated with intrauterine growth restriction, fetal hypoxemia, and preterm labor. Despite unfavorable intrauterine conditions, this premature infant showed normal early neurological development that was verified not only by postnatal tests but also with a new prenatal neurological screening test.

Does ethnicity have an effect on fetal behavior? A comparison of Asian and Caucasian populations.

Abstract Aim: This study aimed to evaluate the ethnic difference in fetal behavior between Asian and Caucasian populations. Methods: Fetal behavior was assesed by Kurjak’s antenatal neurodevelopmental test (KANET) using four-dimensional (4D) ultrasound between 28 and 38 weeks of gestation. Eighty-nine Japanese (representative of Asians) and seventy-eight Croatian (representative of Caucasians) pregnant women were studied. The total value of KANET score and values of each parameter (eight parameters) were compared. Results: The total KANET score was normal in both populations, but there was a significant difference in total KANET scores between Japanese (median, 14; range, 10–16) and Croatian fetuses (median, 12; range, 10–15) (P<0.0001). When individual KANET parameters were compared, we found significant differences in four fetal movements (isolated head anteflexion, isolated eye blinking, facial alteration or mouth opening, and isolated leg movement). No significant differences were noted in the four other parameters (cranial suture and head circumference, isolated hand movement or hand to face movements, fingers movements, and gestalt of general movements). Conclusion: Our results suggest that ethnicity should be considered when evaluating fetal behavior, especially during assessment of fetal facial expressions. Although there was a difference in the total KANET score between Japanese and Croatian populations, all the scores in both groups were within normal range. Our results indicate that ethnical differences in fetal behaviour do not affect the total KANET score, but close follow-up should be continued in some borderline cases.

Diagnosis and counseling of thanatophoric dysplasia with four-dimensional ultrasound

Thanatophoric dysplasia is a severe skeletal disorder with estimated frequency of 0.2–0.5 per 10,000 births. Affected infants die shortly after birth. The diagnosis of thanatophoric dysplasia can be made by two-dimensional ultrasound but the perception of these images is very difficult for the patients. The use of four-dimensional real time ultrasound gives the physician the possibility to discuss and counsel the patients with images that are more understandable to the general public.

Advances in Understanding of Neurophysiological Function of the Fetus

The fascinating journey of the human life begins with two cells merging and continuing to grow into a perfectly designed apparatus comprised of multiple systems working together. Even before one draws his first breath, our nervous system plays the key role of creating a synergy in every single action and process. It all begins during fetal development, which can nowadays be observed and studied through modern imaging technologies, such as ultrasound. This gives the reader an insight on how every part of the nervous system develops and correlates with the developing body using a minimally invasive approach. This article gives an assessment of the knowledge we have regarding fetal neurophysiology and what has been learned about fetal motor and sensory development so far, as well as memory and learning, behavior and emotions and fetal cognitive functions reviewed for selected sections. Furthermore, the article provides a review of how different external factors can harm the fetus and how fetal stress presents a potential threat in fetal neurodevelopment with lasting consequences on brain structure and function. The complexity and maturation processes build up during pregnancy and continue postnatally, allowing further accommodation and development to show the astonishing capacity of brain to learn and adapt.

Reversible peripartum cardiomyopathy in a triplet pregnancy

Peripartum cardiomyopathy (PPCM) is a rare form of dilated cardiomyopathy that occurs in previously healthy women in the last month of pregnancy and up to several months after delivery. The incidence of PPCM is low, but its morbidity and mortality rate are high, with a substantial risk of poor outcome of the pregnancy. Patients who have recovered from PPCM run a high risk of reoccurrence in subsequent pregnancies. In this case report we present a 32-year old female patient who developed acute heart failure (HF) associated with significantly reduced systolic function due to PPCM soon after a delivery of triplets. Treatment was immediately initiated in the intensive coronary unit with oxygen-therapy, loop diuretics, aldosterone blockers, beta blockers, angiotensin-converting enzyme (ACE) inhibitors and bromocriptine. During the follow up period, a year and a half after delivery, a complete recovery of systolic function was observed with no residual symptoms.