On one hand, fetal
neurobehavioral patterns have been considered
indicators of nervous system development. On
the other hand, the capacity of
four-dimensional sonography to evaluate
complex facial expressions allows recognition
of common behaviors with which one can
appreciate the prenatal functionnal
development of the central nervous system.
Using yawning as an example, we review this
interpretation on the basis of knowledge
derived from phylogeny and ontogeny.
As a flip-flop switch,
the reciprocal interactions between sleep-
and wake-promoting brain regions allow the
emergence of distinct states of arousal. By
its ontogenical links with REM sleep, yawning
appears as a behavior which causes an arousal
reinforcement through the powerful stretch
and the neuromuscular connections induced.
Yawning indicates a harmonious progress in
the development of both the brainstem and the
peripheral neuromuscular function, testifying
to the induction of an ultradian rhythm of
vigilance. The lack of fetal yawn, frequently
associated with lack of swallowing,
associated or not with retrognathia, may be a
key to predict a brainstem's dysfunction
after birth.
Medical sonography is a medical
imaging modality used across many medical
disciplines. Its use is growing, probably due
to its relative low cost and easy
accessibility. There are now many high
quality ultrasound imaging systems available
that are easily transportable, making it a
diagnostic tool amenable for bedside and
office scanning. This book includes
applications of sonography that can be used
across a number of medical disciplines
including radiology, thoracic medicine,
urology, rheumatology, obstetrics and fetal
medicine and neurology. The book revisits
established applications in medical
sonography such as biliary, testicular and
breast sonography and sonography in early
pregnancy, and also outlines some interesting
new and advanced applications of
sonography.
Introduction
General movements are
part of the spontaneous movement repertoire
and are present from early fetal life. Prior
to the seventies, self-perception by the
mothers was the only testimony of this fetal
motor activity. The advent of ultrasound
technology in the 1970s enabled live,
unobtrusive observations of fetal behaviors
in humans, vastly increasing our knowledge of
many others more subtle motor activity
(swallowing, respiratory movements, smiling,
hiccup) and thus of the human fetal
development. Our understanding of the orderly
and sequential fetal behavioral's development
increased substantly, leading to a greater
appreciation of the embryologic and
developmental anatomy. The introduction of
four-dimensional ultrasound (4D-US) has led
to very important conclusions concerning
fetal behavior milestones (Kurjak and
Azumendi, 2007). The development of oral
sensorimotor function and swallowing
(essential for the survival) from the fetal
period through early infancy assess normal or
abnormal neurobehavioral development. While
the appreciation of theses functions takes a
long time, another daily behavior will can be
detected: yawning (Yan et al., 2006).
Curiously, little data has been published for
25 years and since the following was written
: "yawning is a universally well known, but
poorly understood"(Sepulveda and
Mangiamarchi, 1995) or "a rudimentary reflex,
appears to have at best an obscure purpose,
if any"(Egerman and Emerson, 1996). Although
remarkably little interest has been paid to
yawning in research, even though it is an
everyday phenomenon, we will discuss the
meaning of this behavior and how its
characterization can enhance neuro-behavioral
understanding.
A popular belief
states that yawning is a response to elevated
CO2 or depressed O2 levels in the blood.
Provine and Tate (1987) found no support for
this hypothesis. Fetal yawning in amniotic
fluid (like a fish's yawn in water) also
speak data against any association between
oxygenation capacity and yawning.
With the significant
advances in the image quality, and resolution
of ultrasound, and now 3D and 4D technology,
the practice of ultrasound examination during
pregnancy steps forward from anatomical
examination to functional evaluation.
Recognition of fetal yawning helps to verify
the harmonious progress of brainstem
maturation, and on the other hand, to
appreciate the neural underpinnings of sleep
and arousal systems. An abnormality of yawn's
occurrence fosters an intensive research of
anemic fetuses (frequency amplified) or
brainstem dysfunction with or without
mandibular hypoplasia (frequency sparse or
null) (Prechtl, 1990). We hope and expect
that upcoming researchs complete the datas
currently available.
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