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Objective: To assess the characteristics of twin fetal facial expressions at 30–33 + 6 weeks of gestation using four-dimensional (4D) ultrasound to clarify twin fetal brain development and maturation. Methods: Frequencies of seven fetal facial expressions were studied using 4D ultrasound for 15 minutes in 30 singleton pregnancies and 18 twin pregnancies [four monochorionic diamniotic (MD) and 14 dichorionic diamniotic (DD) twins] at 30–33 + 6 weeks of gestation. Comparison of the frequency in each facial expression was performed between singleton and twin fetuses. Results: Mouthing was the most frequent facial expression at 30–33 + 6 weeks of gestation, followed by blinking in twin and singleton fetuses. Both facial expressions were significantly more frequent than other expressions (P < 0.05). The frequencies of mouthing and scowling in twin fetuses were significantly lower than those in singleton fetuses, but there were no significant differences in the frequencies of the five other facial expressions between the fetal groups. Conclusion: Our results suggest that restricted twin fetal behavior before 20 weeks of gestation may still affect the frequencies of twin facial expressions early in the third trimester of pregnancy. Moreover, the frequencies of facial expressions in twins are different from those of singleton fetuses. [ABSTRACT FROM AUTHOR]

Objective: To assess fetal behavioral changes in response to vibroacoustic stimulation (VAS) in normal singleton pregnancies using four-dimensional (4D) ultrasound. Methods: Ten types of fetal movements and facial expressions in 68 healthy pregnant women between 24 and 40 weeks were studied using 4D ultrasound for 3 min before and after 3-s VAS. The frequencies of mouthing, yawning, tongue expulsion, back arch, jerky arm movement, startle movement, smiling, scowling, hand-to-face movement, and blinking were evaluated. The fetuses were subdivided into four gestational age groups (24–27, 28–31, 32–35, and ≥36 weeks). Comparison of the frequencies of the fetal behaviors before and after the stimulation in each gestational age group was conducted to detect the response to stimulation with advancing gestation. Results: There were no significant differences in the frequency of each fetal behavior before and after VAS at 24–27, 28–31, and 32–35 weeks of gestation. However, the frequencies of blinking and startle movements were significantly higher after VAS in the 36–40 gestational age group (P < 0.05). Conclusion: The age of 36 weeks of gestation might represent an advanced stage of brain and central nervous system development and maturation as the response to stimuli is prominent at this age compared with earlier gestation. [ABSTRACT FROM AUTHOR]

Objective: To assess whether neurological maturation and development are accelerated in fetal growth restriction (FGR) in utero using four-dimensional (4D) ultrasound. Methods: The facial expressions of 50 appropriate-for- gestational-age (AGA) and 34 FGR fetuses aged between 28 and 35 gestational weeks were assessed using 4D ultrasound. Subsequently, they were differentiated into two gestational age groups (19 aged 28-31 weeks and 31 aged 32-35 weeks in AGA, and 15 aged 28-31 weeks and 19 aged 32-35 weeks in FGR). Fifteen-minute recordings were made, and the frequencies of seven facial expressions during that time were examined. Correlation analysis was conducted to assess the changing number of significant correlations with advancing gestation in each group. Results: Out of 21 combinations of facial expressions at 28-31 and 32-35 gestational weeks in AGA fetuses, there was only three significant correlations. Similarly, only one was noted out of 21 combinations at 28-31 gestational weeks, but there were seven significant correlations in FGR fetuses at 32-35 weeks (P = 0.018). However, there was no significant difference in the number of correlations of facial expressions between AGA (3/21) and FGR (7/21) fetuses at 32-35 weeks of gestation (P = 0.147). Conclusion: Our results suggest that the number of significant correlations of fetal facial expressions in FGR fetuses increases more compared with that in AGA fetuses at 32-35 weeks of gestation. Due to the acceleration of neurological maturation and development in FGR fetuses, the control of facial expressions by the brain may be more evident compared with AGA fetuses at 32-35 weeks of gestation. However, the data and their interpretation in the present study should be taken with some degree of caution because of the small number of subjects studied. Further studies involving a larger sample size are needed to obtain strong or additional evidence. Objective: To assess whether neurological maturation and development are accelerated in fetal growth restriction (FGR) in utero using four-dimensional (4D) ultrasound. Methods: The facial expressions of 50 appropriate-for-gestational-age (AGA) and 34 FGR fetuses aged between 28 and 35 gestational weeks were assessed using 4D ultrasound. Subsequently, they were differentiated into two gestational age groups (19 aged 28-31 weeks and 31 aged 32-35 weeks in AGA, and 15 aged 28-31 weeks and 19 aged 32-35 weeks in FGR). Fifteen-minute recordings were made, and the frequencies of seven facial expressions during that time were examined. Correlation analysis was conducted to assess the changing number of significant correlations with advancing gestation in each group. Results: Out of 21 combinations of facial expressions at 28-31 and 32-35 gestational weeks in AGA fetuses, there was only three significant correlations. Similarly, only one was noted out of 21 combinations at 28-31 gestational weeks, but there were seven significant correlations in FGR fetuses at 32-35 weeks (P = 0.018). However, there was no significant difference in the number of correlations of facial expressions between AGA (3/21) and FGR (7/21) fetuses at 32-35 weeks of gestation (P = 0.147). Conclusion: Our results suggest that the number of significant correlations of fetal facial expressions in FGR fetuses increases more compared with that in AGA fetuses at 32-35 weeks of gestation. Due to the acceleration of neurological maturation and development in FGR fetuses, the control of facial expressions by the brain may be more evident compared with AGA fetuses at 32-35 weeks of gestation. However, the data and their interpretation in the present study should be taken with some degree of caution because of the small number of subjects studied. Further studies involving a larger sample size are needed to obtain strong or additional evidence. [ABSTRACT FROM AUTHOR]

Aim: To assess the effect of psychotropic drugs on fetal behavior using four-dimensional (4D) ultrasound in the third trimester of pregnancy. Methods: Fetal behavior was assessed using Kurjak's antenatal neurodevelopmental test (KANET) using 4D ultrasound between 28 and 36 weeks of gestation. Thirty healthy (control group) and 10 psychotropic-drug-administered pregnant (case group) women were studied. The total value of the KANET score and values of each parameter (eight parameters) were compared between the two groups. Results: The total KANET score was normal (except for one fetus in the case group: total score of 9) in both groups, and there was no significant difference in the total KANET score. When individual KANET parameters were compared, no significant differences were noted in any of the eight parameters. Conclusion: Our results showed that there is no difference in fetal behavior between fetuses of normal pregnant women and those of psychotropic-drug-administered pregnant women in the third trimester of pregnancy. These results suggest that psychotropic drugs may not affect fetal behavioral development in utero. However, the data and their interpretation in the present study should be taken with some degree of caution because of the small number of subjects studied. Further studies involving a larger sample size are needed to assess the effect of psychotropic drugs on fetal neurobehavior during pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To assess the usefulness of the antenatal fetal neurodevelopmental test for the prediction of postnatal developmental disabilities. Methods: Fetal behavior was assessed with Kurjak's antenatal neurodevelopmental test (KANET) using four-dimensional ultrasound between 28 and 38 weeks of gestation. A score range of 0–5 was characterized as abnormal, from 6 to 9 was considered borderline, and 10–16 was normal. After birth, follow-up was conducted for at least 2 years in all fetuses. Results: There were 337 normal (95.47%) and 16 borderline (4.53%) cases among the 353 cases studied, whereas there was no abnormal case. Five cases with postnatal developmental disabilities (one case of Werdig-Hoffmann disease diagnosed just after delivery, one case of autism spectrum disorder diagnosed at 24 months, one case of Ullrich congenital muscular dystrophy diagnosed at 9 months and two cases of developmental disorders diagnosed at age 3 and 18 months) were noted among the 337 normal cases (1.48%), whereas three cases with developmental disabilities (one case of motor development delay diagnosed at 6 months, one case of Duchenne muscular dystrophy diagnosed at 18 months and one case of autism spectrum disorder diagnosed at age 30 months) were found among the 16 borderline cases (18.75%). There was a significant difference in the prevalence of postnatal developmental disabilities between the normal and borderline KANET groups (P<0.001). Conclusion: Our results suggest that the KANET assessment may be a useful diagnostic modality for the prediction of postnatal developmental disabilities. [ABSTRACT FROM AUTHOR]

Objective: To evaluate fetal behavioral differences between singleton and twin fetuses before 20 weeks of gestation using four-dimensional (4D) ultrasound. Methods: 4D ultrasound was used to examine fetal movements in 58 singleton and 48 twin normal fetuses at 12–19 weeks. The frequencies of eight fetal movements were assessed through 15-min recordings. The fetuses were divided into two gestational age groups (12–13 and 14–19 weeks) to evaluate the changes with advancing gestation in twin versus singleton fetuses. Results: Arm and general movements were the most frequent movements in singleton fetuses, whereas only general movement was significantly more frequent than the other seven fetal movements in twin fetuses at 12–13 weeks. At 14–19 weeks, frequencies of arm and leg movements were significantly higher than those of the other six movements in singleton fetuses, while only arm movement was significantly more frequent than the other fetal movements in twin fetuses. Comparisons of fetal movements between singleton and twin fetuses revealed that only arm movement showed a significant difference at 12–13 weeks, while the frequencies of all movements in singleton fetuses were significantly higher than those in twin fetuses at 14–19 weeks. Conclusion: Our results suggest that the limitation of available space and crowding of twin fetuses with advancing gestation may have a marked impact on twin fetal movements compared with singleton fetuses, even in the first half of pregnancy. Further studies are needed to assess whether decreased fetal movements in twin pregnancy can affect fetal and neonatal development and maturation before and after birth. [ABSTRACT FROM AUTHOR]

Fetuses show various facial expressions, such as blinking, yawning, sucking, mouthing, tongue expulsion, scowling, and smiling, assessed by four-dimensional ultrasound from the early second trimester of pregnancy. Moreover, some fetuses demonstrate emotion-like behaviors as noted in infants, children, and adults. Selective fetal responses to stimuli indicate a high degree of brain development, which is reflected in the facial reactions. The fetal face with its movements and expressions can mirror the fetal brain function and development during different stages of the fetus in utero. The fetal face might represent the key to opening the box containing the secrets of fetal brain function and development. Four-dimensional ultrasound may be an important modality in current and future research on fetal facial expressions and assist in the evaluation of the fetal brain function. [ABSTRACT FROM AUTHOR]

Aim: To assess the frequency of fetal movement and reproducibility of fetal movement counting in normal singleton pregnancies early in the second trimester using fourdimensional (4D) ultrasound. Methods: Twenty-nine singleton pregnancies were studied for 15 min employing 4D ultrasound at 14-16 (19 cases) and 17-19 (10 cases) weeks of gestation. The frequencies of eight fetal movements (head anteflexion, head retroflexion, body rotation, hand to face movement, general movement, isolated arm movement, isolated leg movement and mouthing movement) were evaluated. Results: The most frequent fetal movements were isolated arm movements at 14-16 and 17-19 weeks'gestation. There was a significant difference only in the frequency of mouthing movement between 14-16 and 17-19 weeks'gestation (P < 0.05). All fetal movements showed intra- and inter-class correlation coefficients greater than 0.87, with good intra- and inter-observer agreements. Conclusion: The difference in the frequency of mouthing movement at 14-16 and 17-19 weeks'gestation may be due to increasing fetal swallowing because of the increasing amniotic fluid early in the second trimester of pregnancy. To the best of our knowledge, this is the first study on the reproducibility assessment of fetal movement counting using 4D ultrasound. However, the data and their interpretation in the present study should be taken with some degree of caution because of the small number of subjects studied. Further studies involving a larger sample size are needed to assess the reproducibility of fetal movement counting using 4D ultrasound. [ABSTRACT FROM AUTHOR]