Four-dimensional Ultrasound Evaluation of Fetal Neurobehavioral Development

Abstract

The introduction of four-dimensional (4D) ultrasound techniques would facilitate fetal behavioral assessment in three-dimensions in realtime during pregnancy. We describe the latest 4D sonographic studies on fetal behavior, especially fetal whole-body movements and facial expressions in all three trimesters of pregnancy and the continuation of behavior from the fetal to neonatal period. Moreover, we introduce a new scoring system (KANET, Kurjak Antenatal Neurological Test) for assessment of the fetal neurological status using 4D ultrasound. 4D ultrasound also facilitated the evaluation of inter-human contact in twin pregnancies in utero. This novel technique may assist in the evaluation of fetal behavior and inter-twin contact, and offer potential advantages relative to conventional two-dimensional ultrasound. 4D ultrasound should become an important modality in future research on fetal neurobehavioral development and the prenatal identification of severely brain-damaged infants. Further studies involving a larger sample size are needed to ascertain the role of 4D ultrasound in the evaluation of fetal neurobehavioral development.

4D Sonography in Assessment of Fetal Neurobehavior

“…11). There was a significant difference in the total number of all contacts between 10 to 11 and 12 to 13 weeks of gestation in DD twins 17 ( Fig. 12).…”

“…Six MD and eight DD pregnancies were studied for 30 minutes with 4D sonography at 10 to 11 and 12 to 13 weeks of gestation, and a total of 10 intertwin contacts (head to head, head to arm, head to trunk, head to leg, arm to arm, arm to trunk, arm to leg, trunk to trunk, trunk to leg and leg to leg contact) were evaluated. There was a significant difference in the total number of all contacts between MD and DD twins at 10 to 11 weeks of gestation 17 ( Fig. 10).…”

“…A tendency toward a decreasing frequency of facial expression with increasing gestational age needs to be demonstrated'. 17 Yigiter and Kavak 35 also used 4D sonography to investigate 50 normal fetuses in the second and third trimesters. While mouthing, yawning, tongue expulsion, smiling, sucking and swallowing expressions displayed peak frequencies between the 24th and 32nd gestational weeks, grimacing and eye blinking expressions displayed peak frequencies between the 28th and 36th weeks and after the 32nd weeks respectively.…”

“…30,31,[42][43][44] 'However, 2D sonography requires frequent changes of the transducer to visualize both twins simultaneously; even then, complex contacts are not always fully demonstrated, and fetal movements outside the scanning plane cannot be displayed on the monitor because of the 2D character of real-time scanning'. 17 Sasaki et al 45 were the first to evaluate the total number of intertwin contact between monochorionic diamniotic (MD) and dichorionic diamniotic (DD) twins using 4D sonography late in the first trimester of pregnancy. Six MD and eight DD pregnancies were studied for 30 minutes with 4D sonography at 10 to 11 and 12 to 13 weeks of gestation, and a total of 10 intertwin contacts (head to head, head to arm, head to trunk, head to leg, arm to arm, arm to trunk, arm to leg, trunk to trunk, trunk to leg and leg to leg contact) were evaluated.…”

“…16 'Three-dimensional (3D) sonography has the potential to provide improved visualization of fetal anatomic morphology compared with conventional 2D sonographic imaging'. 17 'Because of its 3D imaging capabilities, 3D…”