Maternal perception of fetal motor activity.

A technique using real-time ultrasound for comprehensive recording of fetal motor activity was used in 20 subjects in the third trimester of pregnancy. Maternal awareness of fetal movement correlated with the number of fetal parts contributing to the movement but not with maternal parity or obesity, gestational age, placental site, or duration of the fetal movement. Some subjects recorded fetal breathing, passive fetal displacement, and Braxton Hicks''s contractions as fetal movement. Most of our subjects were consistent and accurate in their perception of major fetal movements, but a few were inconsistent and one was completely unaware of major fetal movements. These results suggest that kick counts kept by most mothers will be accurate. Low counts of fetal movement should be an indication for fetal monitoring by other means and not, unconfirmed, for intervention.     

Influence of Doppler ultrasound on fetal activity.

A randomised and double blind study of 100 subjects and 50 controls was performed to confirm or refute a report from Cardiff in 1975 that continuous Doppler ultrasound, as used in fetal heart rate monitoring, increases fetal movement by over 90%. The results showed such an effect to be most unlikely (power greater than 0.99). A total of 150 pregnant mothers recorded fetal movements for 30 minutes while connected to a specially modified cardiotocograph, the ultrasound being switched on at random for either the first or second 15 minutes in 100 of the patients. The mean difference in 15 minute movement count, with and without ultrasound, among the 100 patients was 0.2 of a movement (SD 12.7; p greater than 0.6 by two tailed Wilcoxon matched pairs signed ranks test). The control group showed a mean difference of 2.6 movements (SD 12.1; p greater than 0.2). Results of a pilot study suggested that the observations in the earlier report may have been influenced by mechanisms unrelated to ultrasound.     

A comparative clinical study of fetal phono- and movement-sensors from Amsterdam,Cambridge and edinburgh

In a European collaboration, a joint project to conduct an experimental and clinical investigation of recently developed sensors from three centres (Amsterdam, Cambridge and Edinburgh) has been carried out. The Amsterdam sensor was based on an inductive principle whereas the Cambridge and Edinburgh transducers used a piezo-electric material (PVDF) as tranducing element. Nine patients with varying gestational age (29–38 weeks) were measured in a clinical investigation. Recordings of fetal heart sounds (FHS) and fetal breathing movements (FBM) were made using three sensors; one from each centre. These recordings were digitized directly into a computer using a purpose-built data acquisition system. For each patient 3 min of FBM data, and 1 min of FHS data were recorded by each sensor. The FBM recordings were carried out simultaneously with ultrasound, so as to enable a correlation to be made between both recordings. The FHS recordings were carried out simultaneously with the maternal heart pulse, to discount any maternal heart influences on the resulting signals. Of the nine patients analysed, FHS were recorded in seven patients. On the other hand, it appeared difficult to identify fetal breathing movements in the FBM recordings due to the dominance of the maternal breathing component. The analysis of the FBM signals and its correlation with ultrasound could not be carried out due to the relatively poor quality of the signals detected by the sensors, given the present techniques of analysis. The evaluation of the FHS recordings showed that although there is relatively little difference between the sensors, the inductive sensor performed best.     

Fetal breathing movements and other tests of fetal wellbeing: a comparative evaluation.

Sixty pregnant women whose fetuses were considered to be at high risk were intensively studied with fetal and placental function tests. Fetal breathing movements were studied with real-time ultrasound and the amount of time spent breathing and the variability of the breath-to-breath interval were measured. A reduction in the amount of time the fetus spent making breathing movements and decreased variability were indicative of fetal compromise. When these results were compared with those of other tests of fetal wellbeing measurement of fetal breathing movements and ultrasound assessment of growth were more sensitive tests of fetal wellbeing than the biochemical measures (urinary oestrogen, human placental lactogen, pregnancy-specific beta-1-glycoprotein, and unconjugated oestriol concentrations) or fetal heart rate. The predictive value was highest with serum unconjugated oestriol but the results of other tests were similar. Study of fetal breathing movements or an ultrasonic assessment of growth may provide a better screening test for fetal compromise than biochemical estimations.     

Spectral analysis of fetal heart rhythm in relation to fetal regular mouthing

Fetal heart rate variation during fetal regular mouthing in behavioural state 1F was investigated applying spectral analysis. Periods with and without fetal regular mouthing movements were compared. The power spectrum of the periods with regular mouthing movements showed a peak at the frequency of the clusters of mouthing movements which was absent in the power spectrum of the corresponding periods without movements. The oscillations in the fetal heart rate associated with this peak in the power spectrum were detectable both in the heart rate tracings obtained from the abdominal electrocardiogram and those recorded by means of wide range Doppler ultrasound.     

Do Facial Expressions Develop before Birth?

Background

Fetal facial development is essential not only for postnatal bonding between parents and child, but also theoretically for the study of the origins of affect. However, how such movements become coordinated is poorly understood. 4-D ultrasound visualisation allows an objective coding of fetal facial movements.

Methodology/Findings

Based on research using facial muscle movements to code recognisable facial expressions in adults and adapted for infants, we defined two distinct fetal facial movements, namely “cry-face-gestalt” and “laughter- gestalt,” both made up of up to 7 distinct facial movements. In this conceptual study, two healthy fetuses were then scanned at different gestational ages in the second and third trimester. We observed that the number and complexity of simultaneous movements increased with gestational age. Thus, between 24 and 35 weeks the mean number of co-occurrences of 3 or more facial movements increased from 7% to 69%. Recognisable facial expressions were also observed to develop. Between 24 and 35 weeks the number of co-occurrences of 3 or more movements making up a “cry-face gestalt” facial movement increased from 0% to 42%. Similarly the number of co-occurrences of 3 or more facial movements combining to a “laughter-face gestalt” increased from 0% to 35%. These changes over age were all highly significant.

Significance

This research provides the first evidence of developmental progression from individual unrelated facial movements toward fetal facial gestalts. We propose that there is considerable potential of this method for assessing fetal development: Subsequent discrimination of normal and abnormal fetal facial development might identify health problems in utero.     

Combined one- and two-dimensional ultrasound system for monitoring fetal breathing movements.

A combined one- and two-dimensional ultrasonic system for monitoring respiratory movements in the human fetus has been developed. A real-time cross-sectional image of the fetal chest at the level of the fetal heart can be obtained, and a time motion recording of fetal respiratory movements can then be written on a strip-chart recorder. Combining the features of one-dimensional and two-dimensional systems produces an accurate means of investigating fetal breathing movements.     

Can Healthy Fetuses Show Facial Expressions of “Pain” or “Distress”?

Background

With advances of research on fetal behavioural development, the question of whether we can identify fetal facial expressions and determine their developmental progression, takes on greater importance. In this study we investigate longitudinally the increasing complexity of combinations of facial movements from 24 to 36 weeks gestation in a sample of healthy fetuses using frame-by-frame coding of 4-D ultrasound scans. The primary aim was to examine whether these complex facial movements coalesce into a recognisable facial expression of pain/distress.

Methodology/Findings

Fifteen fetuses (8 girls, 7 boys) were observed four times in the second and third trimester of pregnancy. Fetuses showed significant progress towards more complex facial expressions as gestational age increased. Statistical analysis of the facial movements making up a specific facial configuration namely “pain/distress” also demonstrates that this facial expression becomes significantly more complete as the fetus matures.

Conclusions/Significance

The study shows that one can determine the normal progression of fetal facial movements. Furthermore, our results suggest that healthy fetuses progress towards an increasingly complete pain/distress expression as they mature. We argue that this is an adaptive process which is beneficial to the fetus postnatally and has the potential to identify normal versus abnormal developmental pathways.     

Central Crosstalk for Somatic Tinnitus: Abnormal Vergence Eye Movements

Background

Frequent oulomotricity problems with orthoptic testing were reported in patients with tinnitus. This study examines with objective recordings vergence eye movements in patients with somatic tinnitus patients with ability to modify their subjective tinnitus percept by various movements, such as jaw, neck, eye movements or skin pressure.

Methods

Vergence eye movements were recorded with the Eyelink II video system in 15 (23–63 years) control adults and 19 (36–62 years) subjects with somatic tinnitus.

Findings

1) Accuracy of divergence but not of convergence was lower in subjects with somatic tinnitus than in control subjects. 2) Vergence duration was longer and peak velocity was lower in subjects with somatic tinnitus than in control subjects. 3) The number of embedded saccades and the amplitude of saccades coinciding with the peak velocity of vergence were higher for tinnitus subjects. Yet, saccades did not increase peak velocity of vergence for tinnitus subjects, but they did so for controls. 4) In contrast, there was no significant difference of vergence latency between these two groups.

Interpretation

The results suggest dysfunction of vergence areas involving cortical-brainstem-cerebellar circuits. We hypothesize that central auditory dysfunction related to tinnitus percept could trigger mild cerebellar-brainstem dysfunction or that tinnitus and vergence dysfunction could both be manifestations of mild cortical-brainstem-cerebellar syndrome reflecting abnormal cross-modality interactions between vergence eye movements and auditory signals.     

Indomethacin reversal of ethanol-induced suppression of ovine fetal breathing movements and relationship to prostaglandin E2

The effects of indomethacin on the ethanol-induced suppression of fetal breathing movements and fetal arterial plasma and cerebrospinal fluid (CSF) PGE2 concentrations and maternal arterial plasma PGE2 concentration were determined in the near-term fetal lamb. Eight conscious instrumented pregnant ewes (between 130 and 133 days of gestation; term, 147 days) received 1-h maternal intravenous infusion of 1 g ethanol/kg total body weight, and the fetus received 6-h intravenous infusion of indomethacin (1 mg/h per kg fetal body weight) commencing 30 min later. Serial fetal and maternal arterial blood samples (n = 8) and fetal CSF samples (n = 5) were collected at selected times throughout the 12-h study for the determination of PGE2 concentration. Fetal breathing movements were monitored continuously throughout the experimental period. Maternal ethanol infusion resulted in initial suppression (P less than 0.05) of fetal breathing movements for 2 h below pretreatment value, followed by a rapid increase in the incidence of fetal breathing movements after the onset of fetal indomethacin treatment. Fetal and maternal plasma PGE2 concentrations and fetal CSF PGE2 concentration were increased (P less than 0.05) above the pre-infusion value during the administration of ethanol and 1 h thereafter. Fetal indomethacin treatment suppressed (P less than 0.05) to undetectable levels fetal plasma and CSF PGE2 concentrations, which then became similar (P greater than 0.05) to pretreatment by 12 h. There was a positive correlation between fetal plasma and CSF PGE2 concentrations. There was an inverse correlation between the incidence of fetal breathing movements and fetal CSF PGE2 concentration.(ABSTRACT TRUNCATED AT 250 WORDS)     

Real-time ultrasonic biparietal diameter of second trimester Suffolk and Finn sheep fetuses and prediction of gestational age

Six Suffolk fetuses of known gestational age were examined every other day from Day 43 to Day 96 of gestation using transabdominal real-time ultrasound. Biparietal diameter (BPD) was measured on symmetrical fetal head images. The relationship between days gestational age (GA) and mean BPD in millimeters is described by the equation: [GA = 22.5 + 1.81 BPD]. Repeated ultrasound examination of 9 Finn ewes between 35 and 95 d of gestation revealed the relationship: [GA = 21.4 + 1.85 BPD]. Biparietal diameters were determined for 56 Suffolk X Hampshire fetuses which ranged from 41 to 77 d of gestation. The predicted fetal age using the Suffolk equation was within 1 d of the recorded age for 22 56 , +/-2 d for 34 56 , and +/-3 d for 44 56 fetuses.     

Doppler ultrasound method for detecting human fetal breathing in utero.

An audible Doppler ultrasound method for detecting human fetal breathing movements in utero has been developed. The frequencies synchronous with fetal breathing movements probably originate from the lung rather than the chest wall. This method is much cheaper and simpler than the ultrasound A-scan method and is suitable for screening large numbers of people.     

高危孕妇胎儿缺氧与彩色多普勒超声结合四维超声检查的相关性研究

摘要 目的：探讨与研究高危孕妇胎儿缺氧与彩色多普勒超声结合四维超声检查的相关性。方法：2018年2月到2020年1月在本院进行建档分娩的高危孕妇108例作为研究对象,都给予彩色多普勒超声结合四维超声检查,记录影像学特征,判定胎儿缺氧发生情况并进行相关性分析。结果：在高危孕妇108例中,发生宫内缺氧28例（宫内缺氧组）,发生率为25.9 %;宫内缺氧组的大脑中动脉、脐动脉的阻力指数（RI）、搏动指数（PI）、收缩期峰值流速舒张期流速比值（S/D）均高于非宫内缺氧组（P<0.05）;宫内缺氧组的上腔静脉血流心室收缩期峰值流速（S波）、心房收缩期速度（A波）、心室舒张期峰值流速（D波）均高于非宫内缺氧组（P<0.05）;高危孕妇108例中,Spearsman分析显示大脑中动脉、脐动脉的RI、PI、S/D以及上腔静脉血流S、D、A均与宫内缺氧都存在相关性（P<0.05）;logistic多因素回归分析显示：大脑中动脉、脐动脉的S/D与上腔静脉血流S、A为导致胎儿缺氧的主要影响因素（P<0.05）。结论：高危孕妇胎儿缺氧与彩色多普勒超声结合四维超声检查特征具有相关性,彩色多普勒超声结合四维超声可作为检查胎儿缺氧的可行、简单无创、方便快捷的方式,具有极高的应用价值。     

The association between cardiac accelerations and movements in fetal sheep

Observations in 5 fetal sheep at 120-134 days gestation, using either real time ultrasound or direct emg recordings to detect fetal movements, showed an association between such movements and cardiac accelerations (greater than 2 s duration and 4 beats/min amplitude). Neuromuscular blockade with gallamine abolished the fetal movements but not the accelerations.     

Measuring movement irregularity in the upper motor neurone syndrome using normalised average rectified jerk.

Movement irregularity is a feature of the upper motor neurone (UMN) syndrome which is difficult to measure. Average rectified jerk (ARJ) has been proposed as a measure of this movement irregularity, but ARJ depends upon the duration of movement. Since movements may be slower in UMN patients, duration dependence compromises ARJ as a measure of irregularity. A normalisation technique is proposed that generates a measure of movement irregularity which is independent of movement duration: normalised average rectified jerk (NARJ). This paper presents a validation of NARJ in the UMN syndrome. Nine control subjects, nine left hemiparetic stroke patients and nine right hemiparetic stroke patients were studied. Test movements comprised elbow extension/flexion in the horizontal plane; these were recorded with an electro-goniometer and accelerometer. The effectiveness of the normalisation technique has been demonstrated using trajectories of various durations; some of these were artificially generated from participants' trajectories, in order to preserve the movement profile. The variability of NARJ and ARJ have been compared in a sample of control subjects. NARJ has been criterion validated by correlation with expert subjective rating of irregularity in a heterogeneous set of trajectories. Construct validity has been tested by discrimination between movements of control subjects, left hemiparetic stroke patients and right hemiparetic stroke patients. When comparing trajectories of identical profile but two-fold difference in movement duration, NARJ differed only 2.6% whereas ARJ differed 706%. NARJ was less reproducible in healthy participants than ARJ: median non-parametric coefficients of variation for repeated movements were 55% and 41%, respectively. Spearman rank correlation coefficient for NARJ and expert rating was 0.92 (p<0.01). NARJ measurements on right hemiparetic patients differ significantly from those made on the control group (p<0.02); corresponding ARJ measurements do not attain statistical significance. NARJ is a valid measure of movement irregularity in the UMN syndrome.     

Use of ultrasound to monitor prenatal growth and development in the common marmoset (Callithrix jacchus)

The increasing use of non-human primates to study fetal development and neonatal management has necessitated the availability of fetuses of known gestational history. In this study, prenatal development and growth were investigated in the common marmoset (Callithrix jacchus) using ultrasound. The objectives of this study were: (1) to determine the accuracy of ultrasound for monitoring prenatal growth and development in common marmosets, (2) to determine if litter size influences prenatal growth trajectories, and (3) to assess growth discordancy among litter mates. Fifty pregnancies were monitored longitudinally using real-time abdominal sonography. During each examination the number of fetuses was recorded, and crown-rump length (CRL) and biparietal diameter (BPD) were measured. The results indicate that ultrasound is a reliable method for observation of gross morphological changes during prenatal development in this species. Measures of CRL and BPD taken early in gestation using ultrasound were in agreement with those from gross specimens. Triplets were significantly (P < 0.05) smaller than twins for both BPD and CRL. No significant relationship was found between litter size and within litter variation in CRL or BPD. This study is the first longitudinal investigation of prenatal growth and development in C. jacchus. The observations from this study will be of use for determining approximate gestational age of fetuses, as well as providing guidelines for routine monitoring of pregnancy in this species. © 1995 Wiley-Liss, Inc.     

Predictors of poor perinatal outcome following maternal perception of reduced fetal movements--a prospective cohort study

Background

Maternal perception of reduced fetal movement (RFM) is associated with increased risk of stillbirth and fetal growth restriction (FGR). RFM is thought to represent fetal compensation to conserve energy due to insufficient oxygen and nutrient transfer resulting from placental insufficiency.

Objective

To identify predictors of poor perinatal outcome after maternal perception of reduced fetal movements (RFM).

Design

Prospective cohort study.

Methods

305 women presenting with RFM after 28 weeks of gestation were recruited. Demographic factors and clinical history were recorded and ultrasound performed to assess fetal biometry, liquor volume and umbilical artery Doppler. A maternal serum sample was obtained for measurement of placentally-derived or modified proteins including: alpha fetoprotein (AFP), human chorionic gonadotrophin (hCG), human placental lactogen (hPL), ischaemia-modified albumin (IMA), pregnancy associated plasma protein A (PAPP-A) and progesterone. Factors related to poor perinatal outcome were determined by logistic regression.

Results

22.1% of pregnancies ended in a poor perinatal outcome after RFM. The most common complication was small-for-gestational age infants. Pregnancy outcome after maternal perception of RFM was related to amount of fetal activity while being monitored, abnormal fetal heart rate trace, diastolic blood pressure, estimated fetal weight, liquor volume, serum hCG and hPL. Following multiple logistic regression abnormal fetal heart rate trace (Odds ratio 7.08, 95% Confidence Interval 1.31–38.18), (OR) diastolic blood pressure (OR 1.04 (95% CI 1.01–1.09), estimated fetal weight centile (OR 0.95, 95% CI 0.94–0.97) and log maternal serum hPL (OR 0.13, 95% CI 0.02–0.99) were independently related to pregnancy outcome. hPL was related to placental mass.

Conclusion

Poor perinatal outcome after maternal perception of RFM is closely related to factors which are connected to placental dysfunction. Novel tests of placental function and associated fetal response may provide improved means to detect fetuses at greatest risk of poor perinatal outcome after RFM.     

European Society of Biomechanics S.M. Perren Award 2018: Altered biomechanical stimulation of the developing hip joint in presence of hip dysplasia risk factors

Fetal kicking and movements generate biomechanical stimulation in the fetal skeleton, which is important for prenatal musculoskeletal development, particularly joint shape. Developmental dysplasia of the hip (DDH) is the most common joint shape abnormality at birth, with many risk factors for the condition being associated with restricted fetal movement. In this study, we investigate the biomechanics of fetal movements in such situations, namely fetal breech position, oligohydramnios and primiparity (firstborn pregnancy). We also investigate twin pregnancies, which are not at greater risk of DDH incidence, despite the more restricted intra-uterine environment. We track fetal movements for each of these situations using cine-MRI technology, quantify the kick and muscle forces, and characterise the resulting stress and strain in the hip joint, testing the hypothesis that altered biomechanical stimuli may explain the link between certain intra-uterine conditions and risk of DDH. Kick force, stress and strain were found to be significantly lower in cases of breech position and oligohydramnios. Similarly, firstborn fetuses were found to generate significantly lower kick forces than non-firstborns. Interestingly, no significant difference was observed in twins compared to singletons. This research represents the first evidence of a link between the biomechanics of fetal movements and the risk of DDH, potentially informing the development of future preventative measures and enhanced diagnosis. Our results emphasise the importance of ultrasound screening for breech position and oligohydramnios, particularly later in pregnancy, and suggest that earlier intervention to correct breech position through external cephalic version could reduce the risk of hip dysplasia.     

Nutritional control of respiratory and other muscular activities in relation to plasma prostaglandin E in the fetal sheep

The effects of nutrient availability on fetal plasma prostaglandin E (PGE) concentrations, on fetal breathing movements and electromyographic (EMG) activities of fetal nuchal and forelimb muscles were investigated in pregnant ewes by varying dietary intake and by manipulation of fetal plasma glucose concentration. The incidence of fetal breathing movements (06.00-10.00 h) decreased with increasing gestational age while fetal arterial concentrations of plasma PGE increased significantly over the same period of gestation. Maternal fasting for 48 h reduced the incidence of fetal breathing movements and the amount of nuchal EMG activity (06.00-10.00 h) in animals older than 130 days but had no effect earlier in gestation. No changes in forelimb EMG activity were observed during fasting at any gestational age. Plasma PGE levels increased significantly during fasts begun both before and after 130 days of gestation. When data from fed and fasted states were combined for all fetuses, irrespective of gestational age, there was a significant inverse correlation between fetal breathing movements incidence and plasma PGE concentration in utero. This relationship was even more pronounced when the fetuses were considered individually. Insulin infusions induced hypoglycaemia, an increase in fetal plasma PGE concentration and a significant reduction in the incidence of fetal breathing movements at all ages. Glucose infusions of fetal breathing movements only after 130 days and had no effect on plasma PGE levels in utero at any gestational age. Neither insulin nor glucose infusions altered the EMG activities of the nuchal and forelimb muscles. The results show that glucose availability is an important factor in determining the incidence of fetal breathing movements in utero and indicate that nutritionally induced changes in fetal breathing movements are mediated in part by PGE. They also suggest that PGE is a physiological regulator of fetal breathing movements in the sheep during late gestation.     

Fetal breathing movements and lung maturation in the congenitally abnormal human fetus

Fetal breathing movements have been studied in conjunction with features of anatomical and biochemical development of the lung at birth in fetuses with congenital abnormalities affecting the respiratory system. Total absence of fetal breathing movements or abnormal fetal breathing movements were associated with lung hypoplasia and failure of normal surfactant release into saline extracts of lung fluid. Surfactant synthesis was demonstrated regardless of the presence or absence of fetal breathing movements. The study supports the hypothesis that normal fetal breathing movements are important for fetal lung development and suggests that surfactant synthesis and its release are independent. The latter process may be dependent upon fetal breathing movements while the former is not.