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Myotonic dystrophy is an autosomal-dominant disorder. Its congenital type is the most severe form, with respiratory failure that can be a life-threatening event after birth. There are no antenatal treatments that can improve neonatal outcomes of myotonic dystrophy. We treated a fetus with congenital myotonic dystrophy by administering indomethacin to the 31-year-old Japanese mother affected by myotonic dystrophy and polyhydramnios. We observed increased fetal breathing movement and a reduction of the amniotic fluid volume. The baby was born at 37 weeks and discharged from the neonatal intensive care unit with a favorable outcome. Indomethacin treatment is likely to improve fetal lung function and to control the amniotic fluid volume. This report emphasizes the importance of further investigations regarding the optimal management of congenital myotonic dystrophy.

The detailed assessment of fetal breathing movement (FBM) monitoring can be a pre-indicator of many critical cases in the third trimester of pregnancy. Standard 3D ultrasound monitoring is time-consuming for FBM detection. Therefore, this type of measurement is not common. The main goal of this research is to provide a comprehensive image about FBMs, which can also have potential for application in telemedicine. Fifty pregnancies were examined by phonography, and nearly 9000 FBMs were identified. In the case of male and female fetuses, 4740 and 3100 FBM episodes were detected, respectively. The measurements proved that FBMs are well detectable in the 20&ndash, 30 Hz frequency band. For these episodes, an average duration of 1.008 &plusmn, 0.13 s (p &lt, 0.03) was measured in the third trimester. The recorded material lasted for 16 h altogether. Based on these measurements, an accurate assessment of FBMs could be performed. The epochs can be divided into smaller-episode groups separated by shorter breaks. During the pregnancy, the rate of these breaks continuously decreases, and episode groups become more contiguous. However, there are significant differences between male and female fetuses. The proportion of the episodes which were classified into minimally 10-member episode groups was 19.7% for males and only 12.1% for females, even at the end of the third trimester. In terms of FBM detection, phonography offers a novel opportunity for long-term monitoring. Combined with cardiac diagnostic methods, it can be used for fetal activity assessment in the third trimester and make measurement appreciably easier than before.

Objective: This study aimed to determine the effect of fetal movements on the MCA pulsatility index (PI) and quantify the fall of MCA PI after initiation of fetal movements and/or breathing, and the time taken to recover from a fall below the 5th percentile. Methods: 16 women with appropriate for gestational age (AGA) fetuses and 16 women with small for gestational age (SGA) fetuses were recruited. MCA PI during “no movement” state was compared with MCA PI values during fetal body movements and breathing movements. Results: MCA PI measurements with body or breathing movements were significantly (p < 0.005) lower as compared to that observed without movements. MCA PI started rising immediately after cessation of body movements and/or breathing movements. Conclusions: MCA PI with fetal body or breathing movements is significantly lower as compared to that observed in the quiet state. If MCA PI measurement is below 5th centile, it should be measured again up to 90 seconds after cessation of fetal body and/or breathing movements in order to minimize false positive diagnosis of cerebral sparing effect in SGA as well as AGA fetuses.

The purpose of fetal magnetoencephalography (fMEG) is to record and analyze fetal brain activity. Unavoidably, these recordings consist of a complex mixture of bio-magnetic signals from both mother and fetus. The acquired data include biological signals that are related to maternal and fetal heart function as well as fetal gross body and breathing movements. Since fetal breathing generates a significant source of bio-magnetic interference during these recordings, the goal of this study was to identify and quantify the signatures pertaining to fetal breathing movements (FBM). The fMEG signals were captured using superconducting quantum interference devices (SQUIDs) The existence of FBM was verified and recorded concurrently by an ultrasound-based video technique. This simultaneous recording is challenging since SQUIDs are extremely sensitive to magnetic signals and highly susceptible to interference from electronic equipment. For each recording, an ultrasound-FBM (UFBM) signal was extracted by tracing the displacement of the boundary defined by the fetal thorax frame by frame. The start of each FBM was identified by using the peak points of the UFBM signal. The bio-magnetic signals associated with FBM were obtained by averaging the bio-magnetic signals time locked to the FBMs. The results showed the existence of a distinctive sinusoidal signal pattern of FBM in fMEG data.

The author, on the basis of numerous studies on the neuropathology of SIDS, performed on a very wide set of cases, first highlights the neuronal centers of the human brainstem involved in breathing control in perinatal life, with the pontine Kölliker-Fuse nucleus (KFN) as main coordinator. What emerges from this analysis is that the prenatal respiratory movements differ from those post-natally in two respects: (1) they are episodic, only aimed at the lung development and (2) they are abolished by hypoxia, not being of vital importance in utero, mainly to limit the consumption of oxygen. Then, as this fetal inhibitory reflex represents an important defense expedient, the author proposes a new original interpretation of the pathogenetic mechanism leading to SIDS. Infants, in a critical moment of the autonomic control development, in hypoxic conditions could awaken the reflex left over from fetal life and arrest breathing, as he did in similar situations in prenatal life, rather than promote the hyperventilation usually occurring to restore the normal concentration of oxygen. This behaviour obviously leads to a fatal outcome. This hypothesis is supported by immunohistochemical results showing in high percentage of SIDS victims, and not in age-matched infant controls, neurochemical alterations of the Kölliker-Fuse neurons, potentially indicative of their inactivation. The new explanation of SIDS blames a sort of auto-inhibition of the KFN functionality, wrongly arisen with the same protective purpose to preserve the life in utero, as trigger of the sudden infant death.

International audience; Fetal activity monitoring is an important part of monitoring at-risk pregnancies and labor. Fetal activity parameters (FAP) consist of fetal heart rate (FHR), fetal movements (FM) rate, fetal tone, fetal breathing (FB) and movement. FAP monitoring is to date an open challenge for mainly two reasons. First, the estimation of FAP is highly time consuming and thus cannot be used routinely. Second, part of FAP such as FM estimation is sometimes subjective (mothers are asked to count the fetal movements) and inaccurate. For this purpose, we developed a 2MHz pulsed wave ultrasound Doppler system, consisting of 12 transducers with 5 adjustable gates. The Doppler signals were sampled at 1KHz. Several recent papers have shown the accuracy of our system. However, its counterpart is the huge number of signals necessary to estimate the FAP. Specifically, each millisecond, 60 Doppler samples are acquired. In order to reduce the volume of the acquired data and to accelerate the FAP estimation rate, we propose herein to investigate the interest of compressive sensing (CS) techniques to our application.

1. In unanaesthetized fetal sheep (greater than 0.8 term) prolonged anaemia initially reduced the incidences of low-voltage electrocortical activity, rapid eye movements and breathing activity; but the incidence of each returned to normal within 4-7 h. 2. Anaemia induced a persistent rise in fetal heart rate and plasma concentrations of adrenaline, noradrenaline and cortisol. 3. After 16 h the fetal haematocrit was returned to normal. Isocapnic hypoxia induced less than 1 h later also inhibited eye and breathing activity. 4. After 1 h fetal arterial PO2 (Pa,O2) was returned to normal. This rise in O2 tension was associated with an elevation in the incidence of low-voltage electrocortical activity, eye movements and breathing. Breathing movements also occurred during high-voltage electrocortical activity. 5. It is concluded that the brain PO2 set-point for hypoxic inhibition adapts rapidly to alterations in O2-carrying capacity and is probably due to changes in the concentration and/or receptor affinity of a central neuromodulator. Secondly, a rise in brain PO2 at birth may contribute to the onset of continuous breathing.

A case is described where prolonged serial observations were carried out on a fetus, between 26 and 3.5 weeks' gestation, the membranes having been ruptured from 23 weeks. No fetal breathing or cyclical activity was observed, and there was no evidence of development of linkage between the fetal behavioral state variables. This was not associated with respiratory morbidity in the neonatal period, but subsequently with severe developmental delay, microcephaly, myoclonic epilepsy and hearing impairment. Absence of fetal breathing may be a more important predictor of prenatal neurological abnormality than of respiratory morbidity following birth. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology

We report a case of Congenital Central Hypoventilation syndrome (CCHS), diagnosed in utero at 18 weeks' gestation analysis of repeats in the PHOX2b gene in fetal amniocytes and confirmed at delivery. Prenatal diagnosis allowed for serial detailed assessment of fetal breathing characteristics. Fetal breathing in this affected fetus was indistinguishable from breathing characteristics in the non-affected fetus.

The hindbrain transcription factors Phox2b and Egr2 (also known as Krox20) are linked to the development of the autonomic nervous system and rhombomere-related regulation of breathing, respectively. Mutations in these proteins can lead to abnormal breathing behavior as a result of an alteration in an unidentified neuronal system. We characterized a bilateral embryonic parafacial (e-pF) population of rhythmically bursting neurons at embryonic day (E) 14.5 in mice. These cells expressed Phox2b, were derived from Egr2-expressing precursors and their development was dependent on the integrity of the Egr2 gene. Silencing or eliminating the e-pF oscillator, but not the putative inspiratory oscillator (preBötzinger complex, preBötC), led to an abnormally slow rhythm, demonstrating that the e-pF controls the respiratory rhythm. The e-pF oscillator, the only one active at E14.5, entrained and then coupled with the preBötC, which emerged independently at E15.5. These data establish the dual organization of the respiratory rhythm generator at the time of its inception, when it begins to drive fetal breathing.

Mind-body therapies have been shown to be effective in clinical treatment of disorders such as high blood pressure and stress. Significant differences in the effectiveness of mind–body therapies have been shown and a common link among the therapies has yet to be defined. This article overviews the role of slow rhythmic breathing in physiological as well as therapeutic effects of mind-body therapies. Slow deep breathing practice has important implications as it may underlie the basic mechanism that synchronizes the brain with the autonomic response. This article reviews studies that include the effect of deep slow breathing with or without mind-body therapy exercises. In utero studies that monitor patterns of fetal breathing reveal sympathetic activation with irregular, shallow fast breathing movements compared to slow deep breathing. Recognition of respiratory mechanisms in mind-body therapies can lead to development of more effective relaxation exercises that may incorporate deep slow breathing in clinical applications.

Using detrended fluctuation analysis (DFA), we studied the scaling properties of the time instances (occurrence) of the fetal breathing, gross-body, and extremity movements scored on a second by second basis from the recorded ultrasound measurements of 49 fetuses. The DFA exponent α of all the three movements of the fetuses varied between 0.63 and 1.1. We found an increase in α obtained for the movement due to breathing as a function of the gestational age while this trend was not observed for gross-body and extremity movements. This trend was argued as the indication of the maturation of lung and functional development of respiratory aspect of the fetal central nervous system. This result may be useful in discriminating normal fetuses from high-risk fetuses.

Persistan pulmoner hipertansiyon PPH yenidoğanda bir grup hastalığın klinik bulgusu olarak karşımıza çıkan, mortalite ve morbiditesi yüksek önemli bir patolojidir. ilk kez 1967 yı- lında, pulmoner vasküler direncin azalmamasına bağlı, postnatal fetal dolaşımın aynen devam etmesi ve duktus arteriosus ve foramen ovaleden sağ-sol şantın kardiyak yapısal anomali olmadan devam etmesi şeklinde tanımlanmıştır. Gerçek insidansı bilinmemekle birlikte ortalama 500-1000 doğumda bir görülmektedir . Çok merkezli bir çalışmada 1.9/1000 olarak bildirilmiştir. Özellikle term ve terme yakın bebeklerde daha sık görülmektedir.

Having previously shown that lesions in the posteromedial group of thalamic nuclei abolish hypoxic inhibition of fetal breathing, we devised this study to identify thalamic loci that depress breathing by focal stimulation of specific sectors of the caudal thalamus and adjacent structures. Multipolar electrode arrays consisting of a series of eight stimulation contacts at 1.25-mm intervals were implanted vertically through guide cannulae into the caudal diencephalon of 12 chronically catheterized fetal sheep (>0.8 term), and central neural tissue was stimulated between adjacent contacts. Each site was stimulated repeatedly with increasing current searching for spatial and stimulus strength parameters for a reliable alteration in respiratory rate. Respiratory period increased when stimulation involved areas of the parafascicular nuclear complex (Pf), which more than doubled the mean period compared with the baseline of 0.90 ± 0.19 s. The change in respiratory period was due to an increase in expiratory time, whereas inspiratory time and breath amplitude were not significantly affected. Breathing period and expiratory time were also increased when the stimulations involved the intralaminar wing surrounding the mediodorsal nucleus, the rostral central gray, zona incerta, and ventral tegmental area. Reductions in respiratory frequency occurred less consistently, with stimulation involving surrounding zones including the sub-Pf, ventromedial nucleus, and ventrobasal nuclear complex. These findings support the hypothesis that a restricted area of the posteromedial thalamus (principally Pf) constitutes part of a neuronal circuitry that modulates respiratory motoneurons.

We have previously found that brief infusion (2 minutes) of a placental extract into the carotid artery inhibited spontaneous fetal breathing in sheep; in 50% of the infusions, the electrocortical activity (ECoG) switched from low voltage (LV) to high voltage (HV). The action was primarily found in the 1-10 kD subfraction and was tissue specific. In the present study we determined the effects of a more prolonged infusion of the 1-10 kD subfraction(over 3 hr) to see if the inhibition of breathing was independent of changes in ECoG and whether it persisted throughout the infusion. Infusion of the 1-10 kD subfraction (40 cc/hr) into the carotid artery of the fetal sheep (139± 2 days of gestation), induced a decrease in the incidence of breathing from 58% (baseline) to 43%, 27%, and 7% during the first, second, and third hour of infusion respectively (p

In mammalian fetuses, such as sheep, behavioural states as determined by continuous recordings of electrocortical activity (ECoG), are welldefined by 0.8 of gestation. A relationship between cerebral oxidative metabolism (COM), ECoG and CBF also exists for the sheep fetus(Richardson et al, 1985). In the llama fetus, high altitude species, CBF does not increase during acute hypoxaemia(Llanos et al, 1995). We determined behavioural states and investigated the association between continous changes in CBF with ECoG in chronically instrumented llama fetuses at 0.60.9 of gestation. Continuous recordings (1.524hs) of ECoG, eye movements(EOG), fetal breathing (FBM), femoral blood flow (FBF) and CBF (Transonic, Inc, 2R) were obtained from 8 llama fetuses at least 3d after surgery. All fetuses demonstrated distinctive cycling between High Voltage (HV) and Low Voltage (LV) ECoG. The mean incidence and episode duration of HV and LV were 57.5% and 15±7 min, and 42.5% and 12.8±5 min, respectively. FBM and EOG, when present, were always associated with LVECoG. Whilst FBF did not change between electrocortical states, a marked increase in CBF(85.2±11.3 to 118±13 ml/min, p

1. Movement of the chest wall and abdomen during episodes of breathing has been measured by an ultrasound technique in ten fetal lambs. 2. The fetal thoracic and abdominal walls move inwards and outwards respectively during inspiration. The position where this transition occurs is variable. 3. Movement of the lateral thoracic walls is reduced or reversed during breathing stimulated by hypercapnia while inward dorso-ventral movement increases. 4. Deep inspiratory efforts were associated with large inward then outward movements of the lateral and large inward movements of the dorso-ventral thoracic walls. 5. No relationship was found between the amplitude of the tracheal pressure deflexions and the extent of thoracic wall movements during fetal breathing.

Hypoplasia of the fetal lungs (L.H.) is found in association with long standing oligohydramnios. In the animal model, interference with fetal breathing (F.B.) activity by phrenectomy or curarization has led to lung hypoplasia. It has been suggested that L.H. associated with oligohydramnios is due to inhibition of F.B. Four patients with oligohydramnios (2 intact membranes, 2 prolonged rupture) were studied in a total of eleven 60-minute sessions from 27-38 weeks. F.B. and other fetal movements (OFM) were recorded using linear array sonography. For each patient study session a gestational, age matched control with normal amniotic fluid volume was studied. Three of the four study subjects had fetal lung hypoplasia. F.B. was observed in all four cases. For the 2 cases with intact membranes (Renal Agenesis and Polycystic Kidneys) F.B. was seen during 0.25±0.048 S.D. [L.H.] of the 60 min observation (control 0.06±0.02). With ruptured membranes F.B. was seen (0.02±0.05 and 0.069 [L.H.] of the time with control of 0.19±0.024). No difference in other OFM was noted. From these preliminary observations we conclude that FB does occur in cases of oligohydramnios associated with lung hypoplasia. It is therefore unlikely that lung hypoplasia is merely the result of absent FB.

Fetal respiratory (FRM)and body movement (FBM) were studied on a transverse cross-section of the fetal upper-abdomen and plotted on a magnetic tape using an event marker. A total of 8 normal and 8 insulin-dependent pregnancies between 29 and 39 weeks was studied. In normal pregnancies, the % incidence of FRM and FBM was calculated from recordings which started 30 minutes before the beginning of a meal and lasted up to 90 minutes following the end of a meal. The meal itself/ starting at 8, 12 and 17 hours lasted 15 minutes during which no recording was made. Maternal blood glucose (MBG) levels were measured every 30 minutes before and following a meal. In diabetic pregnancy, the same procedure was followed, except for breakfast and dinner which was preceded by a 60 minute . recording period, since insulin was administered at 7.30 and 16.30 i.e. 30 minutes before the meal.

Fetal breathing movement (FBM) in utero may be an indicator of fetal health. This paper provides a second-by-second estimate of FBM rate. In the absence of a statistical model for the fetal breathing movement, block data structured autoregressive spectral estimation is used. The optimum tapered Burg algorithm provides a minimum variance breathing rate estimate from a short block of data. The data were recorded using a PVDF (PolyVinyliDeneFluoride) transducer which picks up maternal abdominal wall movements. A peak tracking algorithm is used to extract the fetal breathing rate. Results from these signals are presented in graphical form. Further analysis of the fetal breathing rate has revealed periodicities, similar to that observed in the fetal heart rate.

Investigations of the influence of fetal breathing movements (FBM) upon the fetal heart rate (FHR) have been performed on fetal lambs by FOURON et al. [7], DALTON et al. [3], and on monkey fetuges by MARTIN et al. [10] and ADAMSONS et al. [1], They found that fetal breathing was associated with an increase in heart rate variability, while mean heart rate changed unpredictably, along with a respiratory sinus arrhythmia. So far only three groups have published studies in which both fetal breathing and the FHR have been recorded simultaneously in the human fetuses: TIMOR-TRITSCH et al. [12], WHEELER et al. [13] and DAWES et al. [5]. The purpose of this work is to study the relationship between FHR and fetal breathing. This was done using precision noninvasive ultrasonic techniques capable of simultaneous detection and recprding of the two parameters; thus, in order to do this, a multitransducer with TM-mode recorder was used. This methodology permits a reliable measurement of FHR intervals during apnea and in the presence of fetal breathing

The relationship of breathing to other fetal activities was studied in 8 chronically catheterized pregnant baboons at 138-155 days of gestation following i.v. infusion of 25g of glucose to the mother. No significant changes in fetal heart rate (FHR), FHR variability and fetal or maternal blood pressure were observed during the infusion period. A computer based epoch analysis method was used to automatically detect fetal breaths from a tracheal fluid pressure signal, distinguish episodes of breathing activity from apnea and generate parameters to characterize FBA. Although the number of epochs of FBA was essentially unchanged and breathing rate and variability increased slightly with glucose infusion, significant decreases in other FBA parameters were observed: mean epoch duration decreased from 13.7 to 12.4 sec; median number of breaths per epoch fell from 12 to 6 while the % of time spent in FBA dropped from 20.6% to 10.8%. Finally, mean breathing amplitude also decreased from −8.3 to −6.7 mmHg. These results were unexpected. In human fetuses increases in plasma glucose have been associated with increased FBA. Our results may reflect variation among primate species. Nonetheless we noted that the direction of change in FBA parameters was consistent among all animals and suggests a need for study of the effect of maternal metabolic state on FBA.

Current analytic methods including time and frequency domain approaches are often inadequate to fully characterize FBA. Because of its episodic nature and changing character with gestation, FBA does not lend itself to rigorous statistical analysis. To overcome this problem, we have developed an analytic approach which assumes that the activity occurs quasi-randomly during most of gestation, identifies episodes of activity (breathing) and non-activity (apnea) and characterizes the data within these epochs in a straightforward manner. Using a minicomputer, coded human ultrasonic or baboon tracheal fluid pressure data are digitized, pre-processed for removal of artefacts and breath detection. The distribution of detected breaths is used to identify epochs of FBA and to characterize each epoch with appropriate parameters, including duration, # of breaths, mean fetal breathing rate (FBR), FBR variability and mean breathing amplitude. Tabular and graphical outputs provide epoch by epoch results and summary statistics for a complete study. This approach offers several advantages: 1) data dependence making no assumptions about periodicities or character of breath-activity, 2) focus on the activities of interest while filtering out inherent variability and 3) systematic data reduction and application of standard statistical techniques to multiple recordings from any number of subjects.

The effect of prenatally administered Indomethacin (Indo), a prostaglandin synthetase inhibitor, on alveolar disaturated phosphotidylcholine (DSPC) in the fetal and neonatal rabbit was studied. Pregnant rabbits were injected S.C. with either 0.01 M Na2CO3 or 3 mg/kg Indo in 0.01 M Na2CO3 b.i.d. from 27 through 29 days of gestation inclusive (3 day group). Fetuses were sacrificed on day 30 and the lungs washed with 0.9% NaCl. Newborn pups were delivered and allowed to breathe air for either 0.5 or 1.0 hours and then lung washes obtained. Pregnant does were also given Indo (3 mg/kg b.i.d.) or Na2CO3 on day 29 and fetal lung washes obtained on day 30 (1 day group). Results: Thus during fetal life alveolar DSPC was halved by Indo by 24 hrs but doubled by 3 d. In the pups given 3 d of Indo prior to delivery alveolar DSPC was increased by 54% at 0.5 hrs air breathing but there was no effect by 1 hr. We postulate that Indo temporarily decreases fetal lung surfactant release but that fetal breathing activity is more important in determining release than prostaglandins. Furthermore, Indo does not inhibit the massive release associated with the onset of air breathing.

A technique using real-time ultrasound for comprehensive recording of fetal motor activity was used in 20 subjects in the third trimester of pregnancy. Maternal awareness of fetal movement correlated with the number of fetal parts contributing to the movement but not with maternal parity or obesity, gestational age, placental site, or duration of the fetal movement. Some subjects recorded fetal breathing, passive fetal displacement, and Braxton Hicks's contractions as fetal movement. Most of our subjects were consistent and accurate in their perception of major fetal movements, but a few were inconsistent and one was completely unaware of major fetal movements. These results suggest that kick counts kept by most mothers will be accurate. Low counts of fetal movement should be an indication for fetal monitoring by other means and not, unconfirmed, for intervention.