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Many studies have reported on the association of reduced fetal movements and stillbirth, but little is known about excessive fetal movements and adverse pregnancy outcome. First described in 1977, sudden excessive fetal movement was noted to reflect acute fetal distress and subsequent fetal demise. Subsequently, little was reported regarding this phenomenon until 2012. However, emerging data suggest that 10-30% of the women that subsequently suffer a stillbirth describe a single episode of excessive fetal movement prior to fetal demise. These episodes are poorly understood but may reflect fetal seizure activity secondary to fetal asphyxia, cord entanglement or an adverse intrauterine environment. At present, the challenge in managing women with excessive fetal movements is a timely assessment of the fetus to identify those women at risk of adverse fetal outcomes who may benefit from intervention. [ABSTRACT FROM AUTHOR]

Purpose: Third trimester maternal perception of fetal movements is often used to assess fetal well-being. However, its true clinical value is unknown, primarily because of the variability in subjective quantification. The actograph, a technology available on most cardiotocograph machines, quantifies movements, but has never previously been investigated in relation to fetal health and existing monitoring devices. The objective of this study was to quantify actograph output in healthy third trimester pregnancies and investigate this in relation to other methods of assessing fetal well-being.Methods: Forty-two women between 24 and 34 weeks of gestation underwent ultrasound scan followed by a computerized cardiotocograph (CTG). Post capture analysis of the actograph recording was performed and expressed as a percentage of activity over time. The actograph output results were analyzed in relation to Doppler, ultrasound and CTG findings expressed as z-score normalized for gestation.Results: There was a significant association between actograph output recording and estimated fetal weight Z-score (R = 0.546, p ≤ .005). This activity was not related to estimated fetal weight. Increased actograph activity was negatively correlated with umbilical artery pulsatility index Z-score (R = -0.306, p = .049) and middle cerebral artery pulsatility index Z-score (R = -0.390, p = .011).Conclusion: Fetal movements assessed by the actograph are associated both with fetal size in relation to gestation and fetoplacental Doppler parameters. It is not the case that larger babies move more, however, as the relationship with actograph output related only to estimated fetal weight z-score. These findings suggest a plausible link between the frequency of fetal movements and established markers of fetal health.RATIONALEThe objective of this study was to quantify actograph output in healthy third trimester pregnancies and investigate this in relation to other methods of assessing fetal well-being. This is a widely available method of assessing fetal movements objectively, which has been shown to be an important marker of fetal health. This research is novel in the fact that actograph has never been truly investigated in relation to fetal well-being, despite being available on most cardiotocograph (CTG) machines.Our results show that fetal movements assessed by the actograph are associated both with fetal size in relation to gestation and fetoplacental Doppler parameters. If this proves to be true, smaller babies that move less maybe at particular perinatal risk. [ABSTRACT FROM AUTHOR]

Objectives: To establish reference curves of normal fetal small bowel and colon diameters and to assess the clinical applicability.Method: Serial longitudinal ultrasound examinations at 4-week intervals between 20 to 41 weeks of gestation in 39 low-risk fetuses. The largest loop of the small bowel and colon was identified. The bowel lumen short axis was measured. Linear mixed modeling was used to determine individual developmental trajectories. Twenty-eight fetuses with suspected bowel dilatation were analyzed relative to the reference curves.Results: Development of the small bowel and colon diameters was best described by a linear and cubic model, respectively. The intraobserver and interobserver concordance were >0.94. In cases with suspected bowel dilatation, normal fetal outcome occurred if the bowel dilatation was transient. Progressive increase of fetal bowel diameter was associated with pathology after birth. Cases with small bowel pathology had a z-score >8 after 25 weeks of gestation.Conclusion: We provided the first ultrasound reference curves for normal fetal small bowel and colon diameters. Progressive increase in the fetal bowel diameter z-score was highly predictive of intestinal abnormalities after birth. Longitudinal follow-up of dilated fetal bowel is important to distinguish normality from disease. [ABSTRACT FROM AUTHOR]

Purpose: Donor milk (DM) represents an important nutrition source for high-risk newborns. Holder pasteurization (HoP) is the most recommended procedure for DM treatment, providing a good compromise between microbiological safety and biological quality. HoP was previously shown to affect DM cytokines, growth factors and hormones levels, whilst no data concerning the possible effects of HoP on neurobiomarkers (NB) are available. Therefore, our study investigated whether the concentration in DM of a well-known NB involved in brain development/damage, namely S100B, changes due to HoP.Materials and Methods: We conducted a pretest-test study in 11 mothers, whose DM samples were sub-divided into two parts: the first was immediately frozen (-80 °C); the second was pasteurized with Holder method before freezing. S100B DM levels were measured using a commercially available immunoluminometric assay.Results: S100B protein was detected in all milk samples. Results showed significant differences between groups (p < 0.05) in S100B levels after HoP.Conclusions: Our data provide evidence that S100B is present in preterm milk as well as in term milk during maturation degree. Moreover, the results confirm the susceptibility of this neurotrophic factor to pasteurization stresses and the need to develop new storage techniques to preserve the biological quality of human milk. [ABSTRACT FROM AUTHOR]

Background: Fetal growth restriction (intra-uterine growth restriction [IUGR]) has a considerable impact on perinatal morbidity. Preterm IUGR infants are prone to impaired intestine function. Near-infrared spectroscopy (NIRS) has been used to monitor oxygenation status of the brain and of the intestine.Patients and Methods: We conducted a prospective case-control study at our NICU in 20 preterm infants of whom 10 infants complicated by compared with 10 non-IUGR preterm infants. Splanchnic and cerebral regional oximetry values were measured with NIRS. Three hours of consecutive recordings were performed in the first 24 h of life, T0, and during the transitional period, T1. The cerebral/splanchnic oxygenation ratio, CSOR, (cerebral regional saturations [rScO2]/splanchnic regional saturations [rSsO2]) was also calculated.Results: Both in the IUGR and the non-IUGR infants, at T0 and T1 monitoring time-points, the rSO2 values were higher in the cerebral district when compared to those of the splanchnic area. Comparison of the NIRS parameters between the IUGR and non-IUGR infants at T0 showed no difference in rScO2, while rSsO2 was significantly lower in the IUGR group. At T1, rScO2 was significantly lower and rSsO2 higher in the IUGR group.Conclusions: Cerebral/splanchnic vascular adaptation of IUGR infants to the extra-uterine environment is characterized by a postnatal persistence of the brain sparing effect with reperfusion in the transitional period. [ABSTRACT FROM AUTHOR]

Objective: We evaluated the ultrasound appearance of brain volume and cortical development in fetuses with early growth restriction and placental insufficiency.Methods: We examined a cohort of 20 fetuses with severe intrauterine growth restriction (IUGR) and evidence of placental insufficiency by three-dimensional (3D) ultrasound between 24 and 34 weeks. We graded cortical development and measured the supratentorial intracranial volume. The cortical grading and volume were compared to data obtained from a reference population of 28 adequate for gestational age (AGA) fetuses.Results: Ultrasound examinations were performed in 20 fetuses with IUGR. The biometry and brain volume were significantly reduced in IUGR fetuses. There was evidence of accelerated cortical development in IUGR fetuses.Conclusion: This study confirms that the smaller brain volume in IUGR fetuses, with normal or accelerated cortical maturation as previously depicted with postnatal MRI examination, can be demonstrated by prenatal 3D ultrasound. [ABSTRACT FROM AUTHOR]

Objective: Uptake rates for Down syndrome screening (DSS) in the Netherlands are low compared with those in Northern European countries (27% versus 61% in the United Kingdom and 90% in Denmark). These differences are unexpected, especially since the countries have similar cultural and social values. Method: To analyse factors that underlie differences in uptake we reviewed current literature on individual characteristics and healthcare system factors, which determine potential influential factors on utilization of DSS. Results: Arguments 'Against abortion' and 'Down syndrome (DS) not severe enough condition to terminate pregnancy' correlated with declining DSS, whereas 'Perceived guidance of healthcare professional,' 'Perceived negative attitude of society towards DS' and 'Preparation/Early termination' correlated with accepting DSS. However, the majority of determinants were used both in favour of accepting or declining DSS. Conclusions: Decision making regarding DSS seems a process with influences on different levels and subtle interactions rather than a dichotomous process. Utilization may also be influenced by the implicit way it is being offered, as an extra option or as part of routine care and how this offer is perceived by the social environment. Finally, national healthcare system characteristics, although underrepresented in the examined studies, may also influence participation in DSS. [ABSTRACT FROM AUTHOR]

Backgrounds. The lecithin/spingomyelin (L/S) ratio and lamellar body count (LBC) are two tests that can be used to estimate the probability of the occurrence of respiratory distress syndrome (RDS). Our objective was to compare the prognostic capacity of the L/S ratio and the LBC in the prediction of RDS from amniotic fluid that was obtained either transabdominally or vaginally. Methods. Consecutive women undergoing amniotic fluid sampling for determination of fetal lung maturity were included. In case the membranes were ruptured, amniotic fluid was obtained vaginally. Otherwise, amniotic fluid was obtained by transabdominal amniocentesis. In each specimen, an L/S ratio and a LBC were measured. The predictive capacity of specimens that were obtained vaginally and transabdominally were compared by calculating the area under the receiver-operating-characteristic curve (AUC) analysis. Results. In 260 patients amniotic fluid was collected transabominally, whereas in the other 67 patients there were ruptured membranes, and fluid was collected vaginally. RDS occurred in 25% of the patients without ruptured membranes, and in 34% of the patients with ruptured membranes. For the L/S ratio, the AUC was 0.56 (SE 0.09) for the vaginally collected specimens, and 0.93 (SE 0.02) in the specimens that were collected abdominally. For the LBC, the AUCs were 0.52 (SE 0.08) and 0.84 (SE 0.03), respectively. Conclusions. Fetal lung maturity tests that are performed in vaginally obtained specimens in patients with ruptured membranes are of no use in the prediction of RDS. [ABSTRACT FROM AUTHOR]

We present three cases of spontaneous tachysystole, related to severe myometrium infection and to atypical partial placental abruption. Tachysystole was, in all three cases, associated with repetitive and frequent late decelerations, displaying a pseudo-sinusoidal fetal heart rate (FHR) pattern. Tachysystole, with a pseudo-sinusoidal FHR pattern, may be a sign of a critical perinatal condition and recognition may be of vital importance. [ABSTRACT FROM AUTHOR]

Objectives. Validation of electrohysterography (EHG) as a method for uterine activity monitoring during labour by comparing with intra-uterine pressure catheter (IUPC) recordings. Design. Prospective observational study. Setting. Labour ward in a tertiary centre in the Netherlands. Population. Thirty-two women in labour. Methods. Simultaneous recording of uterine activity with EHG and IUPC for at least 30 min. Main outcome measures. Number of uterine contractions detected by both EHG and IUPC (sensitivity). Number of contractions detected by EHG only [positive predictive value (PPV)]. Correlation between contraction amplitude and duration measured by EHG and IUPC. Results. EHG detects uterine contractions accurately: sensitivity = 94.5% (95%CI: 87.5–100), PPV = 88.3% (95%CI: 76.2–100). The correlation of contractions' duration and amplitude between both methods is r = 0.31 (95%CI: 0.23–0.39) and r = 0.45 (95%CI: 0.38–0.52), respectively. Conclusions. EHG detects uterine contractions accurately during labour but the contraction's characteristics it measures are not directly comparable with that of IUPC. [ABSTRACT FROM AUTHOR]

Background. The choice of first-line tocolytic agent is a topic of worldwide debate. The oxytocin receptor antagonist atosiban and the calcium antagonist nifedipine appear to be effective in postponing delivery. However, information is lacking on their possible effects on the fetal biophysical profile. Objective. To study the direct fetal effects of tocolysis with atosiban or nifedipine combined with a course of betamethasone. Method. We performed a randomised controlled study including women with preterm labour requiring tocolytic treatment. Primary outcome measures were the effects on fetal heart rate (FHR) and its variation. Secondary endpoints were the effects on fetal movement and blood flow (pulsatility index - PI) of the umbilical (UA) and medial cerebral arteries (MCA). Results. One-hour recordings of FHR and fetal movements were made on each of five successive days (days 0-4). Fetal blood flow velocity patterns were studied daily by Doppler ultrasound. Baseline characteristics of 31 women who had not delivered at day 0 and needed no escape tocolysis did not differ between the study groups. Multilevel analysis showed no significant effect of either tocolytic on FHR and movement parameters over the 5-day study period. The use of tocolytics also did not significantly alter the time courses of PI-values for UA (p = 0.37) and MCA (p = 0.62). Conclusion. This study demonstrates for the first time the direct effects of atosiban on fetal movement, heart rate and blood flow. Tocolysis with either atosiban or nifedipine combined with betamethasone administration appears to have no direct fetal adverse effects. [ABSTRACT FROM AUTHOR]

The article provides information on preterm birth (PTB), which is described as the delivery of infant at less than 37 weeks of pregnancy. It discusses the complications of PTB in preterm infants as well as its economic impact. It notes that PTB could be predicted through the identification of the changes in cervical length and levels of fetal fibronection (fFN). It cites that preterm labour can be prevented and managed with the use of tocolytic therapy, corticosteroids, and antibiotics.

Background. Fetal heart rate (FHR) variation and fetal movements show a diurnal rhythm, a rise in the afternoon and evening compared to morning hours. A previous study showed that reductions in fetal parameters occurring two to three days after betamethasone administration are most likely caused by suppression of the normal rise during the day. Therefore monitoring during the morning could circumvent the suppressive effects of betamethasone. Objective. To study the effects of betamethasone on fetal diurnal rhythms, by comparing morning and afternoon recordings over five successive days. Methods. This was a prospective longitudinal study of 20 women at 25-34 weeks of gestation. One-hour recordings of FHR and fetal movements were made on each of five successive days in the morning and afternoon. Betamethasone was administered on day 0 and day 1. Results. We found no reduction of FHR variation on days 2 and 3 in the morning. In contrast, in the afternoon a reduction of FHR variation occurred on day 2. Time courses of fetal body and breathing movements during the morning were not affected by betamethasone administration. Conclusions. Transient reductions in fetal movement and FHR variation after glucocorticoid administration are not observed in the morning. For fetal monitoring and especially for assessing trends in fetal heart rate variation and movements with time, morning recordings should be preferably used in the period around glucocorticoid administration. [ABSTRACT FROM AUTHOR]

Background. Isolated congenital atrioventricular block (CAVB) diagnosed in utero is associated with a high morbidity and mortality. Prognosis is especially poor when heart rate drops below 55 beats per minute (bpm) and when fetal hydrops develops. We describe the natural history and outcome of 24 infants with isolated CAVB diagnosed in utero, review the literature, and assess the risk factors that could predict outcome. Methods. This was a retrospective multicenter study of 24 patients with isolated CAVB diagnosed in utero. Results. CAVB was detected at a mean gestational age (GA) of 24.7 ± 5.1 weeks. Ten fetuses initially presented with complete heart block. Low heart rate or incomplete heart block was the first documentation of bradyarrhythmia in the other 14 fetuses. In 11 of them, CAVB developed during pregnancy after a median time of 3 (range 1-16) weeks. Fetal hydrops developed in 10 of 24 (42%) fetuses at a mean GA of 27.6 ± 5.1 weeks. Hydropic fetuses showed lower heart rates during pregnancy (47 ± 10 bpm) than non-hydropic fetuses (57 ± 10 bpm). There were three intrauterine deaths; all were hydropic and female. Nine viable females and 12 males were born at a mean GA of 37.1 ± 6.1 weeks with an average birth weight of 3097 ± 852 g. Fifteen CAVB patients required pacemaker (PM) intervention, 10 of them immediately after birth. Dilated cardiomyopathy (DCM) developed in three infants of whom two died of congestive heart failure, shortly after the diagnosis was made; one is still alive. Mortality before or after birth was 21%, and was associated with heart rates below 50 bpm and development of fetal hydrops. Poor outcome, defined as death, PM implantation, or development of DCM, occurred in 83% of cases and was associated with heart rates below 60 bpm during pregnancy. Conclusions. Isolated CAVB diagnosed in utero is associated with high morbidity and mortality. Patients who develop fetal hydrops show lower heart rates during pregnancy than patients who do not. A fetal heart rate below 50 bpm and development of fetal hydrops is associated with increased mortality. Rates below 60 bpm are associated with PM requirement and/or DCM. [ABSTRACT FROM AUTHOR]

Objective: To study respiratory outcome in preterm small for gestational age (SGA) fetuses with or without signs of intrauterine growth restriction due to placental insufficiency, and with or without maternal hypertension. Methods: This was a retrospective study of 187 neonates with birth weight <10(th) percentile and gestational age <34 weeks. Results from umbilical artery Doppler velocimetry were used to identify the abnormal Doppler subgroup. Results: No significant difference in respiratory outcome between SGA fetuses with normal (SGA-N) or abnormal (SGA-A) umbilical artery Doppler examination was found. Within the SGA-A group, the respiratory distress syndrome (RDS) incidence (OR 5.6, 95% CI 1.7-18.3), RDS grade (OR 6.7, 95% CI 1.2-38.5), and need for surfactant (OR 5.3, 95% CI 1.1-24.4) were higher in infants of women with hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome as compared to those of normotensive mothers. Conclusions: Lung maturation is not accelerated with placental insufficiency. SGA-A fetuses of mothers with HELLP syndrome have a significantly poorer respiratory outcome than those with healthy mothers. Possibly, fetuses of mothers with HELLP syndrome are subjected to 'oxidative stress' causing lung damage rather than lung maturation. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to visualize and quantify dynamic changes in the cervix and to study factors influencing cervical length. Methods: Eighteen women with a gestational age between 23 and 40 weeks were examined by transvaginal ultrasound during a continuous observation period of 30 minutes. Results: All women delivered at >34 weeks of gestation, fourteen at term. The overall mean difference between the shortest and longest cervical length during the 30-minute recordings (cervical length variation) was 10.9 mm (range 1.6-26.7 mm). In the presence of fetal movements directed at the cervix, peristaltic movement of the bowel or contractions, cervical length variation was larger than in the absence of these conditions (mean 12.7 mm, range 5.2-26.7 mm and mean 6.1 mm, range 1.6-9.4 mm, respectively; p = 0.03). Conclusions: Dynamic changes in cervical length are present at early gestation and long before delivery and can be observed either spontaneously or associated with contractions, fetal movements or peristalsis. These conditions must be considered as pitfalls in cervical length measurement. In critical cases, such as early threatened preterm labor, increases in the frequency and duration of sonographic ultrasound measurements may be helpful to obtain a more reliable estimation of the cervical status. [ABSTRACT FROM AUTHOR]

In this review we give an overview of the methods and pitfalls in cervical length measurements. We compared the different techniques and investigated factors that influence visualization of the cervix. The data in this overview may be used to establish guidelines in clinical practice. [ABSTRACT FROM AUTHOR]

Objective . To determine if there is a diurnal pattern in the clinical symptoms of HELLP (Hemolysis, Elevated Liver enzymes, Low Platelets) syndrome. Study design . A retrospective study was performed in 134 pregnancies complicated by HELLP syndrome. The medical records were reviewed to describe each HELLP episode. Time of day was divided into three periods, day, evening, and night. The following parameters were categorized according to the time of day: onset of symptoms, consultation by the doctor, initial blood sampling, diagnosis and decrease of symptoms. Biochemical parameters at clinical presentation and consecutive changes within 24 h were recorded. Results . In 65 pregnancies 77 HELLP episodes were well documented. Times of onset of symptoms and consultation by the doctor were significantly higher during the evening and night ( p 9 /l. Several hours later (median 8 h, range 2–23) the decrease in platelets occurred. Conclusions . A diurnal pattern exists in the clinical symptoms of HELLP syndrome that is characterized by an exacerbation during the night and recovery during the day. There is a considerable delay between the onset of symptoms and the fulfilment of diagnostic laboratory criteria. [ABSTRACT FROM AUTHOR]

Our aim was to review the literature on umbilical cord coiling. Relevant articles in English published between 1966 and 2003 were retrieved by a Medline search and cross-referencing. The normal umbilical cord coiling index (UCI) is 0.17 (+/- 0.009) spirals completed per cm. Abnormal cord coiling, i.e. UCI <10th centile (<0.07) or >90th centile (>0.30) is associated with adverse pregnancy outcome. Hypocoiling of the cord is associated with increased incidence of fetal demise, intrapartum fetal heart rate decelerations, operative delivery for fetal distress, anatomic-karyotypic abnormalities and chorio-amnionitis. Hypercoiling of the cord is associated with increased incidence of fetal growth restriction, intrapartum fetal heart rate decelerations, vascular thrombosis and cord stenosis. It is not clear whether abnormal coiling is actually a cause of pathology, or merely one of the sequelae, or both. We discuss the theories involving the cause of cord coiling, and the consequences of the degree of cord coiling on blood flow through the umbilical vessels. In the future ultrasonographic evaluation of the umbilical cord and the UCI may become an integral part of fetal assessment in high-risk pregnancies. [ABSTRACT FROM AUTHOR]

Measurement of amniotic fluid (AF) lactate concentration in complicated pregnancies may provide information on the extent of fetal acidemia. However, normalisation for AF volume may be necessary by calculating the lactate:creatinine (L:C) ratio. We measured these AF parameters and compared them to arterial cord blood lactate in 28 term and 10 preterm pregnancies. Cord blood lactate was not correlated to AF lactate, but was correlated to the L:C ratio in the complete study population ( R = 0.54, p = 0.001) and the subgroups. Correlation was strongest in a preterm intrauterine growth restricted subgroup ( n = 7, R = 0.83, p = 0.02). The L:C ratio is more accurate in estimating fetal lacticaemia than AF lactate. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether outcome differs between pregnancies complicated by gestational diabetes mellitus (GDM), which was either detected by risk-factor based screening when no clinical signs are apparent (screening-group) or due to clinical signs of hyperglycemia (e.g. accelerated fetal growth or hydramnios) (diagnosis-group). Methods: A retrospective cohort of 249 patients with GDM treated between 2006 and 2009 were identified: 74 in the diagnosis-group and 175 in the screening-group. Fetal macrosomia was defined as an abdominal circumference (FAC) >90th percentile at the time of diagnosis of GDM. Large for gestational age (LGA) was defined as a birthweight >90th percentile, corrected for gestational age, parity and sex. Results: GDM was diagnosed 4 weeks later in the diagnosis-group. At diagnosis of GDM, more infants in the diagnosis-group had a FAC >p90 and at birth more infants in this group were LGA. Conclusion: GDM diagnosed by screening is associated with a lower incidence of fetal and neonatal macrosomia than GDM diagnosed by clinical symptoms. A later diagnosis of GDM is more prevalent in presumed low-risk pregnancies. These results favour a policy of routine screening. [ABSTRACT FROM AUTHOR]

Ultrasound studies of fetal motor behavior provide direct - in vivo - insight in the functioning of the motor component of the fetal central nervous system. In this article, studies are reviewed showing changes in the first timetable of appearance of fetal movements, changes in quality and/or quantity of movements and disturbances in the development of fetal behavioral states in case of endogenous malfunctions, maternal diseases and exogenous behavioral teratogens. [ABSTRACT FROM AUTHOR]

We evaluated the feasibility of demonstration of the embryonic cerebral ventricles using three dimensional transvaginal ultrasonography and software which has been developed to automatically calculate the volume of ovarian follicles after ovarian stimulation. In four out of six subsequent ultrasound examinations which were done for determination of gestational age from eight to ten gestational weeks, sufficient resolution was obtained to demonstrate the embryonic cerebral ventricles with automated volume calculation software, yielding striking images of a dramatic stage of embryonic development. [ABSTRACT FROM AUTHOR]