Le bâillement, du réflexe à la pathologie
Le bâillement : de l'éthologie à la médecine clinique
Le bâillement : phylogenèse, éthologie, nosogénie
 Le bâillement : un comportement universel
La parakinésie brachiale oscitante
Yawning: its cycle, its role
Warum gähnen wir ?
 
Fetal yawning assessed by 3D and 4D sonography
Le bâillement foetal
Le bâillement, du réflexe à la pathologie
Le bâillement : de l'éthologie à la médecine clinique
Le bâillement : phylogenèse, éthologie, nosogénie
 Le bâillement : un comportement universel
La parakinésie brachiale oscitante
Yawning: its cycle, its role
Warum gähnen wir ?
 
Fetal yawning assessed by 3D and 4D sonography
Le bâillement foetal
http://www.baillement.com

mystery of yawning 

mise à jour du
30 septembre 2013
Maedica
2011;6(2); 120 -127
lexique
The Role of 4D Ultrasound in the
Assessment of Fetal Behaviour
 
Lebit F-D, Vladareanu R
 
University of Medicine and Pharmacy "Carol Davila",
Elias University Emergency
Hospital, Bucharest, Romania
 

Chat-logomini

Tous les articles conascrés au bâillement foetal
Fetal yawning: all publications
 
Video de bâillement foetal à 23 semaines en Echo 4D
Fetal yawning : a behavior's birth with 4D US revealed
Bâillements du foetus: la naissance d'un comportementrévélée par l'échographie 4D Dr O.Walusinski
 
 
fetal yawn
 
Fetal behavior is defined as any fetal action seen by the mother or fetus diagnosed by objective methods such as cardiotocography (CTG) or ultrasound. Analysis of the dynamics of the fetal behavior with morphological studies has lead to the conclusion that fetal behavior patterns are directly reflecting development and maturation of the central nervous system. The assessment of fetal behavior by 4D ultrasound could allow distinction between normal and abnormal fetal behavior patterns which might make possible the early recognition of fetal brain impairment.
 
Assessment of fetal movements throughout the pregnancy using 4D ultrasound.
 
The study group included 144 healthy pregnant women with single pregnancies between 7-38 weeks of gestation. For the first trimester of pregnancy we assessed eight types of fetal movements and for the second and third trimesters 14 types of fetal movements and facial expressions. The analyzed parameters for each trimester of pregnancy can be used for performing antenatal neurodevelopment test, used the first time by Professor Kurjak.
 
After 15-20 minutes 4D ultrasound examination, we found a pattern of fetal behavior for each trimester of pregnancy. Dynamic evaluation of fetal behavior reflects directly the processes of maturation and development of the central nervous system. This can make the difference between normal and abnormal brain development and may be used for early diagnosis of neurological disorders that become manifest in perinatal and postnatal periods.
 
 
Introduction
In the past, registration of fetal movements and fetal heart rate auscultation were the only methods of the follow-up of fetal well being. In the last few decades, the development of new ultrasound techniques has allowed direct visualization of the fetus in utero (1,2).
 
4D ultrasound has recently been introduced in medical practice and complements 2D and 3D examination by obtaining images in real time. 4D ultrasound allows visualization of embryonic movements two weeks earlier than 2D ultrasound (1). In comparison with 2D ultrasound, 4D ultrasound offers real benefits for fetus's assessment prenatal condition. The most benefits of 4D ultrasound could be real time assessment of fetal face, grimacing, breathing movements, swallowing, mouthing, isolated eye-blinking and reveals the direction of the limbs. In a relatively short period of time 4D ultrasound stimulated multicentric studies on fetal and even embryonic behaviour with more convincing imaging than conventional 2D ultrasound.
 
A large spectrum of neurological problems, such as attention deficit hyperactivity disorder, schi zo phrenia, epilepsy, autism could be result at list in part from prenatal neurodevelopment pro blems (1,2).
 
The fetuses with abnormal fetal behaviour should be followed at least till the age of two years when their categorization to disabling or non-disabling cerebral palsy can be possible. It is well known that fetal movement occurs far earlier than a mother can register it, at the end of the embryonic period (1). Pattern of the mo vements, its quantity and quality is expanding rapidly during pregnancy, from gross movements of the whole embryo to organized movements and facial expressions towards the end of the pregnancy.
 
Understanding the relationship between fetal behavior and brain developmental processes in different periods of gestation makes it possible to distinguish between normal and abnormal central nervous system (CNS) development and early diagnosis of various structural and functional abnormalities.
 
 
fetal yawning
 
 
Discussion
 
In the first trimester, fetal movements grow rapidly in frequency and complexity. If around 7 weeks of pregnancy only gross movements are visible, at the end of the first trimester fetus presents complex movements of the head, limbs and fingers. Initially hand contact with different parts of the body or the uterine wall is accidental (2).
 
In the second half of the pregnancy, the motor behavior significantly increases in frequency and variability. After 15 weeks of pregnancy, 15 types of movements are finalized (3): general body movements, isolated arm movements, isolated leg movements, head retoflexion, anteflexion and rotation, hand to head, hand to eye, hand to mouth, hand to face, hand to ear, mouth movements: yawning, sucking, swallowing, opening/closing the mouth. Mouth mo vements could be observed, particularly, du ring the absence of general movements periods and they reflect normal neurological development of the fetus (1,2,5).
 
Additionally, during the second trimester, facial expressions and eye movements occur. The first eye movements are sporadic and occur at about 18 weeks. Around 24-26 weeks, eye movements are more frequent and systematic alternating with periods when they are absent. All types of facial expressions (movements of the mouth, smiling, frowning) showed a maximum frequency at the end of the second trimester (11).
 
In late pregnancy, fetal movements show a decline and the periods of rest start to grow. This decrease is rather a consequence of the brain maturation processes than the reduced amount of amniotic fluid (2,3). The results of multicentric studies from Croatia, Spain, Turkey, Qatar, Sudan and Japan, showed similar distribution of fetal movements according to gestational age.
 
The study of fetal behaviour was a concern (even before the appearance of 4D ultrasound) for teams coordinated by De Vries and Prechtl. Five years ago, Professor Kurjak implemented antenatal neurodevelopment test (KANET) in Zagreb University hospital. The score is calculated after the assessment quantitatively and qualitatively of the parameters described above. Further, the assessment of the fetal behaviour was applied in other university centers from Croatia, Spain, Turkey, Qatar and Japan. In cases of definitely abnormal or borderline score the test should be repeated every two weeks till delivery. After that the babies require postnatal neurological development follow-up for a two years period.
 
Conclusions
 
Behaviour is closely related to fetal development and maturation processes of the central nervous system. Widespread assessment of the fetal movements can diagnose early many neurological diseases that have their origins more in peri- and postnatal periods than during intrauterine period.
 
The identification of neurological problems during fetal life is based on evaluation of opening of the eyes, variety of facial expression, primary reflexes (rhythmical burst in the sucking pattern) and quality of general movements. The identification of dynamic and static patterns of the symptoms may be helpful to date precisely the time when the insult occurs. The major problem in studying fetal behavior is that it requires a significant amount of time and it has not become an ultrasound exam routine. The bias in examination can be eli mi nated by use of ultrasound recordings. Frequent use of the KANET score would bring a series of benefits and would solve situations in which obstetriciens are considered accountable for neurological injury in the neonatal period.