Sanja Zaputović

Intrauterine Growth restriction and cerebral Palsy

Intrauterine growth restriction (IUGR) can be described as condition in which fetus fails to reach his potential growth. It is common diagnosis in obstetrics, and carries an increased risk of perinatal mortality and morbidity. Moreover, IUGR has lifelong implications on health, especially on neurological outcome. There is a need for additional neurological assessment during monitoring of fetal well-being, in order to better predict antenatally which fetuses are at risk for adverse neurological outcome. Studies have revealed that the behavior of the fetus reflects the maturational processes of the central nervous system (CNS). Hence, ultrasound investigation of the fetal behavior can give us insight into the integrity and functioning of the fetal CNS. Furthermore, investigations carried out using modern method, four-dimensional (4D) sonography, have produced invaluable details of fetal behavior and its development, opening the door to a better understanding of the prenatal functional development of the CNS. Based on previous observations and several years of investigation, our reaserch group has proposed a new scoring system for the assessment of fetal neurological status by 4D sonography named Kurjak antenatal neurodevelopmental test (KANET). The value of KANET in distinguishing fetal brain and neurodevelopmental alterations due to the early brain impairment in utero is yet to be assessed in large population studies. However, preliminary results are very encouraging.

Combination of vibroacoustic stimulation and acute variables of mFBP as a simple assessment method of low-risk fetuses

Objectives. To observe a rate of fetal breathing and gross body movement appearance as physiologic reactions to the external vibroacoustic stimulation (VAS) and to establish a rapid and reliable antepartal method for accurate selecting of non-compromised fetuses in the low-risk population. Methods. Actual condition of 742-term and near-term structurally normal and otherwise healthy singleton fetuses with favourable outcome was assessed by previously established combination of the modified fetal biophysical profile and VAS. Only inactive fetuses at the beginning of the testing were included in the study. The combined biophysical testing has been started by a transabdominal real-time ultrasound examination, followed by vibroacoustic stimulus applied over the fetal head for 5 s during fetal quiescence. Fetal breathing and gross body movements were observed with particular attention in each case at measured time intervals from the application of external VAS until the moment at which either the first 60-s episode of breathing movements or all three fetal gross body movements were detected. Obtained results have been presented numerically in 5-min periods and cumulative percentages. Results. After the external VAS, 84.5% of studied fetuses successfully manifested their normal breathing or gross body movements in the first 5 min of the modified biophysical testing. Furthermore, approximately 96% of them were able to demonstrate at least one of these two biophysical activities after 6–7 min. Discussion. Because of its simplicity, non-invasiveness, independence of precise gestational dating, reproducibility and immediate individual results, ultrasonographic observation of normal fetal breathing and/or gross body movements after the external VAS stands a real chance to become a nearly optimal antenatal test for accurate and rapid information of actual non-compromised fetal condition. Authors strongly believe that the described antenatal method should represent a rather efficient assessment procedure of fetal well-being in late pregnancy, performed during regular antenatal visits.

Fetal ultrasound biometry for pregnant population in the County of Primorje-Gorski Kotar (Croatia)

Objective. To create curves of three most commonly used biometric parameters for singleton pregnancies from 22 to 41 weeks of gestation in the County of Primorje-Gorski Kotar (Croatia) and to compare results with other studies. Methods. From January 2002 to December 2009, ultrasound examination was performed on fetuses of 1248 pregnant women with uncomplicated pregnancy. Values for biparietal diameter, femur length, and fetal abdominal circumference were measured. Results were compared with studies pertaining to European and North American population. Mean, percentile scale, and Wilcoxons matched pairs test were used. Regression analysis was applied to analyze data correlation and to determine correlation quotients. Results. Total of 2178 measurements for fetal biometry charts were performed. Established mean and centile values for fetal biometry parameters are reported numerically and graphically. Comparison of obtained values with values of identical fetal biometric parameters of other world populations has revealed statistically significant differences (p < 0.01). Conclusion. Normal fetal biometry charts for population of pregnant women in the northern coastal region of Croatia were constructed. Due to existence of statistically significant differences in ultrasound fetal biometry values among various populations under comparison, construction of own charts and their implementation in routine obstetrical work are justified.

Incidence of the 35delG/GJB2 mutation in low-risk newborns.

Objective. To investigate, in a prospective study, the incidence of homozygotes and heterozygotes of the 35delG/GJB2 mutation for connexin 26 in the low-risk population of newborns undergoing two-stage universal neonatal hearing screening (UNHS). Patients and methods. The study population consisted of 1048 neonates born at the Department of Obstetrics and Gynecology, Rijeka University Hospital, Croatia, in the period between March 1, 2005 and June 30, 2005. The neonates underwent a two-stage UNHS program that included evoked otoacoustic emission (E-OAE) in all infants and automated auditory brainstem response (A-ABR) in those who did not pass the E-OAE. The 35delG/GJB2 mutation was determined in the umbilical cord blood of all examinees. Results. Fifteen out of 1048 infants (14.3 per 1000) did not pass the E-OAE, of whom three (2.86 per 1000) did not pass the A-ABR (two unilateral, one bilateral). The 35delG/GJB2 mutation was found in 13 out of 1033 infants who did pass the E-OAE and in one who did not pass the E-OAE. Thirteen out of 14 infants were heterozygotes (12.4 per 1000) and one infant was homozygote (0.95 per 1000) for the 35delG/GJB2 mutation. The homozygous infant had a bilateral pathological result on E-OAE and A-ABR, while 13 infants who were homozygotes passed the E-OAE. Conclusion. In all neonates, regardless of hearing impairment, genetic testing for the 35delG/GJB2 mutation is desirable in southern Croatia. The incidence of affected homozygous and healthy heterozygous transmitters of the 35delG/GJB2 mutation was in concordance with findings in southern European countries.

The secular growth acceleration: does it appear during fetal life?

Abstract Objective: To test if secular growth acceleration occurs during fetal life. Methods: ANOVA Kruskal–Wallis and Mann–Whitney U-test have been used for the biometric characteristics comparison of nowadays fetal population with those three decades ago and to test the hypothesis about the existence of secular growth acceleration during fetal life. For this purpose, we first calculated mean values of particular biometric parameters for the whole pregnancy. During the period 2002–2009 biparietal diameter, fetal length and abdominal circumference measurements in singleton uncomplicated pregnancies between 22 and 41 gestational weeks were obtained. Gestational age was estimated according to Naegeles rule and confirmed with an early ultrasound examination. Pregnancies with fetal cromosomopathies and malformations were excluded as well as those resulting in perinatal death. Results: There were no statistically significant differences of the examined fetal biometric parameters measured by ultrasound between contemporary fetal population and those from 35 years ago. Conclusion: Our investigation did not undoubtedly prove that significant changes of fetal biometric parameters occurred in the last three decades. It is possible that secular growth acceleration does not exist in prenatal period but also the observed time period could have been short for this phenomenon to manifest.