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

mystery of yawning 

mise à jour du
12 décembre 2010
Journal of Obstetrics and Gynaecology
Efficacy of assessment in fetal behaviour by four dimensional ultrasonography
T.-H. KIM, J. J. LEE, S.-H. CHUNG, H.-H. LEE, K. H. LEE, K Y. CHOI & S. H. LEE
Department of Obstetrics and Gynecology, College of Medicine, Soonchunhyang University, Republic of Korea


Tous les articles consacrés au bâillement foetal
Fetal yawning: all publications
This study was conducted to examine the behaviour and facial expressions of the fetus after birth by 4-dimensional (4-D) ultrasonography, and the association of the biophysical profile (BPP) with the Doppler scale. A total of 40 singleton pregnancies were included. All 4-D ultrasonographies were performed using the Accuvix XQ (Medison® Co. Ltd, Seoul, Republic of Korea). The BPP and Doppler were performed on gravidas using 2-D ultrasonography. We recorded the newborn while awake no later than 48 h after delivery. The most frequent movement in fetuses and newborn was yawning and isolated arm movements, respectively. Sucking, swallowing (r= 0.78) and isolated limb movements (r= 0.72) in fetuses as observed by 4-D ultrasonography had a relationship with isolated limb movements in the newborn. Because of the limitation of ultrasonography, an overall comparison could not be made. There was a high correlation between sucking, swallowing, and isolated limb movements in fetuses and newborn.
In pregnant women, the methods of assessing fetal wellbeing include the biophysical profile (BPP) and the measurement of arterial blood flow volume in the uterus or umbilical cord; however, the methods are limited (Kurjak et al. 2005a; Wu et al. 2007). Facial expressions and movements of the ferns are known to be an indirect expression of the maturity of cerebral function during the fetal period.
It has been reported that facial expression during the fetal period corresponds to facial expression during the neonatal period (Kurjak et al. 2007a). If brain function after birth could be predicted by antepartum 4D ultrasonography, early management after birth may be optimised.
Materials and methods
Between October 2007 and December 2008, 40 gravidas with singletons between 28 and 32 weeks' gestation underwent prenatal examinations at a university hospital. After obtaining approval from the Institutional Review Board (IRB), the weight and size of the ferns were measured by 3-5 MHz ultrasonography. By measuring the Doppler waveforms of the umbilical cord, uterine artery and middle cerebral artery (MCA), abnormalities of the fetal intrauterine environment were assessed. The fetal
facial expressions and movements were assessed every 3 weeks by 4-D ultrasonography (Accuvix XQ, Medison® Co. Ltd, Seoul, Republic of Korea) for 30 min. A BPP was performed twice. The exclusion criteria included cigarette smoking during pregnancy, a history of drug abuse, twin pregnancies, fetal deformities, genetic diseases, intrauterine growth retardation and fetal hydrops. Gestational age was determined based on the first day of the last menstrual period (LMP) or by ultrasonographic dating of the early pregnancy. Initially, the study was conducted on 45 gravidas. Five gravidas were high risk (diabetes mellitus, hypertension, or oligohydramnios). Among the high-risk gravidas, three gravidas could not be assessed because of premature rupture of membranes (PROM) and the resulting oligohydramnios, and two gravidas underwent early delivery due to pregnancy-induced hypertension (PIH). The five newborn could not be examined for neonatal movements due to intubation, hence they were excluded from the study.
The mean age of the gravidas was 31.7 ± 4.7 years and the parity was 0.2 ± 0.6. The gestational age at delivery was an average of 38.0 ± 1.7 weeks. At the time of birth, the Apgar scores were recorded and the weights and head circumferences were measured. Physical abnormalities, and the Moro, plantar, grasping, sucking, and tonic neck reflexes were assessed.
A video recording was performed for 30 min using a video camera (Sony®, Sony Co. Ltd, Tokyo, Japan) in the newborn nursery no later than 48 h after birth. The video was compared with the ultrasonographic images and analysed. For the fetal facial expressions and movements, the Kurjak classification (Table I) was used, as defined in Figure 1 (Kuijak et al. 2003).
The neonates were separated from other neonates, clothed, and while lying in the supine position, the video recording was performed while awake and moving the limbs freely. The temperature of the newborn nursery was 25°C. Crying, nursing, hiccoughing, or administering drugs to the newborn were excluded from video recording. The video recording was focused on the head area of the newborn, and the video recording technicians were instructed not to disturb the actions of the newborn. To determine the association between the movements of the fetuses with the newborn, SPSS 12.0K was used, and a correlation and correlation coefficient were determined with Spearman's rank order correlation, and p values were determined.
Table I. Classification of facial expression and movement patterns - 12 different activities.
1. Mouthing movement: consisted of a series of rhythmic movements involving the mandible and tongue, characterised by constant frequency and duration until disappearance
2. Yawning: slow and prolonged wide opening of the jaws followed by quick closure with simultaneous retroflexion of the head and sometimes elevation of the arms of exoration. The duration is about ˆ3 s
3. Tongue expulsion: facial activity characterised by mouth opening with protruding of fetal tongue
4. Smiling: the expression consists of the bilateral elevation of the mouth angle
5. Scowling and grimacing: the expression consists of bilateral contraction of eyebrows and mimic musculature between them
6. Sucking and swallowing: rhythmical bursts of regular jaw opening and closing at a rate of about 1/s may be followed by swallowing, indicating that the fetus is drinking amniotic fluid. Swallowing consists of displacements of the tongue and/or larynx
7. General movements: this category is applicable if the whole body is moved but no distinctive patterning or sequencing of the body parts can be recognised. The complex movements of the limb, trunk and head are clearly visible and cause a shift in fetal position
8. Startle: a startle is a quick generalised movement, always initiated in the limbs and sometimes spreading to the neck and trunk
9. Stretch: a stretch is a complex motor pattern, which is always carried out at a slow speed and consists of the following components: forceful extension of the back, retroflexion of head, and external rotation and elevation of the arms 10. Isolated limb movement: these may be rapid or slow movement, and may involve extension, flexion, external and internal rotation, or abduction and adduction of an extremity, without movements in other body pans 11. Isolated retroflexion of the head: retroflexions of the head are usually carried out slowly, but they can also be fast and jerky. The displacement of the head can be small or large. The latter may cause over-extension of the spine of the fetus 12. Isolated anteflexion of the head: anteflexion of the head is carried out only at a slow velocity. The displacement of the head is small. The duration is about 1 s.
This study was conducted to provide a standard screening method to predict the development of the nervous system of newborn by measuring facial expressions and behaviour changes using 4-D ultrasonography, BPP and Doppler. If we can predict that newborn infants progress to cerebral palsy by 4-D ultrasonography, it may be associated with fetal sucking, swallowing, and isolated limb movements. Using 4-D ultrasonography, fetal movement was measured quantitatively from 14 weeks' gestation. Indeed, 4-D ultrasonography has been used as a method to observe limb movement before fetal movements are perceived (Kuno et al. 2001b; Timor-Tritsch and Platt 2002; Kuijak et al. 2005; Tonni et al. 2005; Yan et al. 2006). Using 4-D ultrasonography, the fetal limbs in gravidas with diabetes mellitus could be observed at about 8 weeks' gestation. Fetal movements in gravidas with diabetes mellitus develop slower than in healthy gravidas. By 4-D ultrasonography, the assessment of fetal movement in the first or second trimester is an important method to assess wellbeing (Kuijak et al. 2002, 2006).
The complex developmental process of the CNS and the dynamics of the development of the sensory system are not well understood (Sepulveda and Mangiamarchi 1995; Hadders-Algra 1997; Zuk et al. 2008). Recently, it has been reported that fetal facial expression corresponds to behaviour and sensory system of the newborn, as observed by 4-D ultrasonography (Kuijak et al. 2004; Hata et al. 2005). The differences in the movement of fetuses can be assessed. It has been reported that the general movements (swallowing, stretching, and yawning) are associated with the number of axodendritic and axosomatic synapses (Sepulveda and Mangiamarchi 1995; Hata et al. 1998; Andonotopo and Kuijak 2006; Luchinger et al. 2008).
Between 28 and 32 weeks' gestation, the entire image of fetus cannot be seen on a monitor; only a portion of the trunk or the limbs can be observed. Thus, the movement of the entire body is difficult to observe by 4-D ultrasonography. To understand fetal movements, the period before the third trimester is desirable. Therefore, we recommend evaluating the function of the fetal CNS by observing facial expression rather than the movement of the entire body during the third trimester of pregnancy. In previous studies, tongue expulsion was difficult to observe (Yigiter and Kayak 2006); however, in the current study, tongue expulsion was observed. It is speculated that fetal tongue expulsion can be used as an index to observe changes in fetal facial expression.
The ultimate purpose of evaluating the development of the CNS by 4-D ultrasonography is to determine whether 4-D ultrasonography could serve as a prenatal diagnostic method to detect cerebral palsy prior to birth. In addition, 4-D ultrasonography may become a method to assess fetal wellbeing (Kuijak et al. 2007b; Kuijak et al. 2008a). New fetal nervous behaviours were observed in the fetuses of healthy and high-risk gravidas by examining two cranial closure areas by 3-D ultrasonography, and by scoring facial expression and fetal movement (Kuijak et al. 2008b). A postnatal follow-up study was performed, and it became the basic research that facilitates detection of anomalies involving the nerves and CNS; however, in cerebral palsy, it is not easy to clearly detect abnormal development of the CNS (Salihagic-Kadic et al. 2005).
In the current study, because of the limitation of 4-D ultrasonography, an overall comparison was impossible. The ferns was analysed based on the images of fetal movement recorded on ultrasonography (sucking, swallowing, and isolated limb movements), which were highly correlated with newborn measurements.
The current study was limited by the small study population and consisted of healthy gravidas without obstetric or medical problems. It was not easy to perform ultrasonography for 30 min. Due to PROM and pre-term birth after performing 4-D ultrasonography, five pregnant women were excluded in our study. We were not able to include high-risk pregnant women with deterioration of labour pain when we performed 4-D ultrasonography for 30 min. We should consider the necessary time to perform 4-D ultrasonography on high-risk pregnant women because >30 min may aggravate pre-term labour in our study.
We suggest that obstetricians should perform 4-D ultrasonography on pregnant women with normal BPP and Doppler between 28 and 32 gestational weeks. Four-D ultrasonography may predict nervous system development in the fetus by confirming sucking, swallowing and isolated limb movements.
Our study is the first report from the Republic of Korea in which fetal behaviour was assessed by BPP, Doppler, and 4-D ultrasonography, and compared with the newborn.