The potential of 4D sonography in the assessment of fetal behavior in high-risk pregnancies

Talić, Amira; Kurjak, Asım; Ahmed, Badreldeen; Stanojević, Milan; Predojević, Maja; Kadić, Aida Salihagić; Renzo, Gian Carlo Di

doi:10.3109/14767058.2010.534830

Cited by 310 publications

(57 citation statements)

References 30 publications

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“…Fetal KANET scores from low-risk and high-risk pregnancies were compared, and the difference was statistically significant. 59 Statistically significant difference was found between KANET scores of the fetuses from the low-risk group compared to the following subgroups of the high-risk group: previous child diagnosed with CP, hypertension (RR > 160/100), threatened preterm delivery, maternal fever, IUGR, Rh isoimmunization, placental bleeding. Furthermore, KANET scores significantly differed comparing threatened preterm delivery with PPROM vs threatened preterm delivery without PPROM; hypertension above 160/100 mm Hg vs hypertension below 160/100 mm Hg; diabetes before pregnancy vs gestational diabetes; IUGR with decreased resistance index (RI) of middle cerebral artery (MCA) vs IUGR without decreased RI of MCA; and Rh isoimmunization without hydrops fetalis vs Rh isoimmunization with hydrops fetalis.…”

Section: Prenatal Neurological Assessmentmentioning

confidence: 97%

“…58 New results regarding the potential of 4D sonography in the assessment of fetal behavior in high-risk pregnancies were recently published. 59 The group in Khartoum applied KANET to large number of fetuses during the period of one year. The aim of the study was to assess the behavior in large sample of fetuses from normal and high-risk pregnancies by application of the KANET scoring test and to compare the scores obtained in low-and high-risk pregnancies.…”

Section: Prenatal Neurological Assessmentmentioning

confidence: 99%

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Fetal Brain Function: Lessons Learned and Future Challenges of 4D Sonography

Kurjak¹,

Predojević²,

Kadić³

2011

Donald School Journal of Ultrasound in Obstetrics and Gynecology

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Maturation of the central nervous system (CNS) is reflected in fetal behavior. Modern technology, such as four-dimensional (4D) sonography improved assessment of fetal behavior in all three trimesters of pregnancy. After summing our own experiences and experiences of the leading authors in the field of fetal and neonatal neurology, new prenatal screening test for assessment of fetal behavior has been suggested. Test was named Kurjak antenatal neurodevelopmental test (KANET). Up to now results of KANET are encouraging and they have been published in several prominent journals. Nevertheless, potential of KANET in the assessment of integrity of the fetal central nervous system needs to be confirmed by studies that are in progress in several world university centers.Keywords: Fetal brain development, Four-dimensional ultrasound, Neurological deficit, Perinatal neurological assessment. PRENATAL MORPHOLOGICAL AND FUNCTIONAL DEVELOPMENT OF THE FETAL CENTRAL NERVOUS SYSTEMDevelopment 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. Early embryonic development is characterized by its immobility. Important prerequisite for fetal movements is the existence of the interneuronal and neuromuscular connections. The earliest interneuronal connections, the synapses, can be detected in the spinal cord shortly before the onset of embryonic motility, at 6 to 7 weeks of gestation.1 Therefore, the neural activity leading to the first detectable movements is considered to originate from the spinal motoneurons.2 As mentioned, another important prerequisite for the motility is the development and innervation of muscle fibers. It is well known that primitive muscle fibers (myotubes) are able to contract as soon as they are innervated by motor neurons.3 Between 6 and 8 weeks of gestation, muscle fibers have formed by fusion of myoblasts, efferent and afferent neuromuscular connections have developed, and spontaneous neural activity causing motility can begin. The first spontaneous embryonic movements are gross body movements and they can be observed at the 7 to 7.5th week of gestation. They consist of slow flexion and extension of the fetal trunk, accompanied by the passive displacement of arms and legs. These so-called vermicular movements appear in irregular sequences. Simultaneously with the onset of spontaneous movements, at the 7.5th week of gestation, the earliest motor reflex activity can be observed, indicating the existence of the first afferentefferent circuits in the spinal cord. The first reflex movements are massive and indicate a limited number of synapses in a reflex pathway. General movements are the first complex, wellorganized movement pattern, which involve head, trunk and limb movements. This pattern has been interpreted as the first sign of a supraspinal control on motor activity and can be recognized from 8 to 9 weeks of gestation onwards. 4 The brainstem is fashioned around the 7th week of gestati...

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Section: Prenatal Neurological Assessmentmentioning

confidence: 97%

Section: Prenatal Neurological Assessmentmentioning

confidence: 99%

Fetal Brain Function: Lessons Learned and Future Challenges of 4D Sonography

Kurjak¹,

Predojević²,

Kadić³

2011

Donald School Journal of Ultrasound in Obstetrics and Gynecology

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“…A recent prospective longitudinal cohort study evaluating four-dimensional sonography in the assessment of fetal behavior in high-risk pregnancies [39] applied KANET in 620 singleton pregnancies between 26 and 38 weeks of gestation, in a 1-year period from January to December 2007. The study showed that KANET was able to identify borderline and abnormal fetal behavior in high-risk patient groups, such as gestosis and FGR [39] . These results support growing evidence that many neurological disorders originate from intrauterine rather than peri-or postnatal periods.…”

Section: Fetal Behaviormentioning

confidence: 99%

“…Previous studies clearly showed signifi cant differences in fetal behavior, in at risk-vs. normal pregnancies [1,39] . Several pathological processes are involved in triggering the process which leads to brain injury and results in alterations of fetal behavior.…”

Section: Introductionmentioning

confidence: 99%

Comparison between antenatal neurodevelopmental test and fetal Doppler in the assessment of fetal well being

Kurjak

Talić

Honemeyer

et al. 2012

Journal of Perinatal Medicine

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Aims: The primary aim of this study was to compare circulatory changes in the fetal brain under certain pathological conditions with alterations in fetal behavior. Patients and methods: A prospective longitudinal cohort study on fetal behavior of fetuses from singleton pregnancies between the 28 th and 38 th gestational week in the period from March 2009 to October 2011 was undertaken. There were 596 fetuses in the high-risk group and 273 fetuses in the low-risk group. Elevated umbilical artery Doppler pulsatility index and reduced middle cerebral artery pulsatility index obtained in the absence of fetal movements were considered abnormal. The Kurjak Antenatal Neurodevelopmental Test (KANET) was used to assess fetal behavior. Results: Statistically signifi cant differences in the distribution of normal, abnormal, and borderline KANET scores between low-risk and high-risk groups were found. Furthermore, 596 fetuses from the high-risk group were subdivided into subgroups according to the risk factor. The largest proportion of abnormal KANET scores (23.9 % ) was in the subgroup of fetuses whose mothers had an offspring diagnosed with cerebral palsy (23.9 % ), followed by the proportion of borderline KANET scores in the subgroup of fetuses from febrile mothers (12.7 % ). Fetal behavior was signifi cantly different between the normal group and the following subgroups of fetuses: fetal growth restriction (FGR), gestational diabetes mellitus, threatened preterm birth, antepartal hemorrhage, maternal fever, sibling with cerebral palsy, and polyhydramnios. Conclusions: A new clinical application of the KANET test in early identifi cation of fetuses at risk for adverse neurological outcome was demonstrated.

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“…Ten out of 36 fetuses with abnormal KaNeT had postnatal neurological evaluation after 2 and 6 months indicating seriously abnormal findings: four of them had severe generalized spasticity. 45 Honemeyer et al performed KaNeT test in 100 fetuses, with postnatal follow-up immediately after birth and at 12 weeks of age, with systematic neurological evaluation by a neonatologist. The results of pre-and postnatal scoring systems were compared, showing that normal prenatal KaNeT score is significantly predictive of the normal postnatal neurological examination of the newborn.…”

mentioning

confidence: 99%

Recent Results of the Clinical Application of Kanet Test

Neto¹,

Kurjak²

2015

Donald School Journal of Ultrasound in Obstetrics and Gynecology

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Many investigations led to the conclusion that fetal behavioral patterns directly reflect developmental and maturational processes of fetal central nervous system (CNS), and may make possible to distinguish between normal and abnormal brain development as well as prenatal diagnosis of neurological impairment. The arrival of three-and four-dimensional ultrasound (3D/4D US) made possible to study fetal behavioral patterns. Kurjak's antenatal neurodevelopmental test (KANET) is the first prenatal test based on 3D/4D ultrasound examination of the fetus, that could be used for the evaluation and prediction of fetal neurological status. Here, we present our review of literature on KANET around the world and summarized results of this promising prenatal neurological screening test.

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The potential of 4D sonography in the assessment of fetal behavior in high-risk pregnancies

Abstract: KANET test has the potential to detect and discriminate normal from borderline and abnormal fetal behavior in normal and in high-risk pregnancies.

Cited by 310 publications

References 30 publications

Fetal Brain Function: Lessons Learned and Future Challenges of 4D Sonography

Fetal Brain Function: Lessons Learned and Future Challenges of 4D Sonography

Comparison between antenatal neurodevelopmental test and fetal Doppler in the assessment of fetal well being

Recent Results of the Clinical Application of Kanet Test

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