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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.

This paper proposes a detection method of fetal breathing movement (FBM) as an important data of fetal well-being. To analyze the chaotic nature of the individual episodes, the frequency band has been split into single test frequencies in order to find its starting point (SP) as a signal free (quiet) zone. Computing some features of the signal the sound will be distinguishable from the disturbing signals as hiccups, body's rotation and limb movements or even additional noises of maternal heart beats. The SPs of the episodes are characterized by an approximation process in order to select the real ones.Clinical relevance- The method is an irradiation free measurement, carried out on the maternal abdomen. Furthermore, connected with the fetal phonocardiographic (fPCG) monitoring the method offers a non-invasive way for FBM detection applicable also at home. More than 50 pregnancies were examined with the proposed method for at least for 20-min with synchronous measurements by the proposed phonographic device and a 3D ultrasound machine in the third trimester.

Objectives Absence of fetal breathing movements (FBM) has been found to be a good predictor of preterm delivery in symptomatic patients. However, analysis of FBM patterns and Doppler measurement of them for preterm birth prediction have not been performed before. In this study, we aimed to investigate and analyze FBM patterns in symptomatic preterm labor patients by fetal ultrasonography and nasal Doppler. Methods This was a multicenter, prospective cohort study. Singleton pregnant patients between 24 and 37 gestational weeks diagnosed with preterm labor were included in the study. Patients were evaluated in three groups: no FBM (Group 1), regular FBM (Group 2), irregular FBM (Group3). Results Seventy-three patients were available for the final analysis after exclusion. Preterm delivery rate in 24 h in groups were 91.7, 32.7 and 100%, respectively. The absence of FBM (Group 1) was statistically significant for preterm delivery in for both 24 (91.7 vs. 42.6%, p=0.002) and 48 h (91.7 vs. 49.2%, p=0.006) when compared with fetal breathing positive Group 2 and 3. In fetal nasal Doppler analyses in Group 2, the inspiration/expiration number rate was significantly lower in the patients who delivered in 24 h (0.98±0.2 vs. 1.25±0.57, p=0.015). By using fetal nasal Doppler, combination of absence of FBM or irregular FBM or regular FBM with inspiration number/expiration number (I/E) Conclusions Examining FBM patterns and using nasal Doppler may help the clinician to differentiate those who will deliver preterm and may be an invaluable tool for managing preterm labor patients.

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.

Fetal movements, which include body and breathing movement, are important indicators of fetal well-being and nervous system development. These have been shown to be affected by intrauterine conditions. While maternal physical activity does induce a change in intrauterine conditions and physiology, its impact on fetal movements is still unclear. This paper will provide a brief review of the literature and outline the current knowledge with regards to the effects of maternal exercise on fetal body and breathing movements.

To evaluate the relationship between gestational diabetes mellitus (GDM) and fetal activity.We prospectively studied 18 pregnant patients with GDM and 20 pregnant patients with normal glucose screening test. An ultrasound equipment was used to perform a 30 min transabdominal sonographic recording for each patient. Each ultrasound exam was recorded using a DVD recorder. Fetal activity was analyzed using duration and number of episodes of fetal breathing and body movements. The recordings were analyzed using a stopwatch in order to accurately evaluate each recording. The data was statistically analyzed using the parametric and non-parametric t-test.The results of the study indicated that there was a significant correlation (p = 0.007) between the duration of fetal breathing movement and GDM. Fetuses of mothers suffering from GDM had a significantly longer duration of fetal breathing movements compared with fetuses of non diabetic mothers. In addition, the total duration of fetal activity (time of fetal body movements plus fetal breathing movements) was significantly higher (p = 0.005) in GDM compared with non GDM pregnancies. The difference in fetal body movements between GDM and normal pregnancies was not statistically significant.The results of this study support the hypothesis that GDM has a direct influence on fetal activity. The significance of this finding should be further evaluated.

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.

To observe a rate of fetal breathing and gross body movement appearance as physiologic reactions to the external vibroacoustic stimulation (VAS) and to establish a rapid and reliable antepartal method for accurate selecting of non-compromised fetuses in the low-risk population. Actual condition of 742- term and near-term structurally normal and otherwise healthy singleton fetuses with favourable outcome was assessed by previously established combination of the modified fetal biophysical profile and VAS. Only inactive fetuses at the beginning of the testing were included in the study. The combined biophysical testing has been started by a transabdominal real-time ultrasound examination, followed by vibroacoustic stimulus applied over the fetal head for 5 s during fetal quiescence. Fetal breathing and gross body movements were observed with particular attention in each case at measured time intervals from the application of external VAS until the moment at which either the first 60-s episode of breathing movements or all three fetal gross body movements were detected. Obtained results have been presented numerically in 5-min periods and cumulative percentages. After the external VAS, 84.5% of studied fetuses successfully manifested their normal breathing or gross body movements in the first 5 min of the modified biophysical testing. Furthermore, approximately 96% of them were able to demonstrate at least one of these two biophysical activities after 6-7 min. Because of its simplicity, non- invasiveness, independence of precise gestational dating, reproducibility and immediate individual results, ultrasonographic observation of normal fetal breathing and/or gross body movements after the external VAS stands a real chance to become a nearly optimal antenatal test for accurate and rapid information of actual non-compromised fetal condition. Authors strongly believe that the described antenatal method should represent a rather efficient assessment procedure of fetal well-being in late pregnancy, performed during regular antenatal visits.

Objective: To develop a model to study the fetal effects of intrapleural infusion of OK-432 (Picibanil), a pleurodesis agent derived from killed Gram-positive streptococci. Methods: OK-432 (0.1 mg, n = 5), or normal saline (n = 5) were infused over 20 min into the pleural space of chronically instrumented preterm fetal sheep at 0.7 gestation. Fetal physiological parameters, including breathing and nuchal activity were monitored in utero from 6 h before infusion until 12 h afterward, and fetuses were killed after 7 days recovery. Results: OK-432 was associated with transient suppression of fetal EEG activity, breathing and body movements from 3–6 h after infusion. Hypotension and hypoxia did not occur. At postmortem, local pleural adhesions were seen around the site of OK-432 infusion but not in saline treated fetuses. Conclusions: Intrapleural administration of OK-432 is associated with marked but transient fetal behavioral effects. This model will enable preclinical investigation of the neural and cardiovascular safety of OK-432 at a clinical relevant stage of development.

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.

To study the utility of fetal heart rate (FHR) monitoring and actocardiogram for fetal diagnosis and the classification of fetal behavioral states, a comparison of the techniques and their results ...

Main points: role in lung development, apneic intervals and noncontinuous nature, increasing compatibility or less with other motions, consequences of their fetal features on the premature and neonate, and shallow fetal breathing as indicator of state

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.

The high risk attributed to multiples calls for close observation during pregnancy. Based on adequate predictions in singletons, it was expected that the biophysical profile (reactive fetal heart rate pattern on non-stress test, presence of fetal breathing and body movements, documentation of normal fetal tone and adequate amount of amniotic fluid) could be used in multiples as well. However, the paucity of studies could not demonstrate an equivalent predictive capacity in multiple pregnancies.

Using a novel isolated hindbrain in vitro preparation, we demonstrate that, in the mouse, branchiomotor activities from trigeminal, facial, glossopharyngeal and vagal nerves start during segmentation, a crucial and conserved period of hindbrain embryogenesis. At embryonic day (E) 10.5, branchiomotor nerves are independently active in bursts, become coactive at a low frequency (about 0.5 min-1) at E12.5, before high frequency (about 15 min-1) fetal breathing starts at E14.5. Comparison with observations in chick reveals a transient episodic rhythmic pattern highly similar in mouse at E13.5 and chick at E7. This pattern is proposed as a marker identifying a phylotypic stage during the development of hindbrain neuronal networks in vertebrates.

Objective. A congenital diaphragmatic hernia (CDH) is the most common intrathoracic extracardiac congenital anomaly, and it is associated with high mortality and other fetal abnormalities. Early diagnosis is essential for delivery planning and possible intervention. However, the in utero diagnosis of CDHs by sonography can be challenging. We report the utility of paradoxical movement of the intra-abdominal contents in identifying CDHs. Methods. Two fetal cases were identified: 1 referred with a suspected CDH and the other with a mediastinal shift and a suspected congenital cystic adenomatoid malformation (CCAM). Real-time sonography was performed in both fetuses with attention on movement of the intra-abdominal contents during fetal breathing, particularly during inspiration. Results. Real-time sonography in both fetuses showed paradoxical movement of the abdominal contents during fetal inspiration. In the case with the presumptive diagnosis of a CCAM, the paradoxical motion was essential in changing the diagnosis from a CCAM to a CDH. Conclusions. Paradoxical movement of the abdominal contents can be used in addition to the traditional sonographic signs in diagnosing CDHs.

In order to test the effects of maternal exercise in late gestation on fetal biophysical activities as measured by fetal breathing, shoulder movement, and kick response, these parameters were monitored by ultrasound in ten healthy pregnant women at 35 weeks of gestation before and after 20 minutes of aerobic dance and before and after 20 minutes of rest. A randomized crossover design between exercise (sequence A) and rest (sequence B) that used each pregnant woman as her own control was used in this study. Cumulative means for each fetal activity were compared. Results indicated a significant decrease in fetal breathing after maternal exercise and no significant change in shoulder movements or kick response.

Purpose To determine whether fetal acoustic stimulation can decrease the time required to achieve a reassuring biophysical profile. Methods Patients scheduled for a biophysical profile were prospectively assigned to study and control groups. The study group received 3 seconds of acoustic stimulation if fetal breathing, tone, or movement were not present during the first 5 minutes of the study. The biophysical profile was completed in the standard fashion, for both groups. Results A total of 870 patients were enrolled (458 control, 412 with stimulation). The fetal acoustic stimulation group had decreased testing time (3 minutes) and fewer non-reassuring tests (5%). The fetal acoustic stimulation group had fewer studies without breathing, potentially reducing the need for further testing or intervention. Conclusions Fetal acoustic stimulation can be used to decrease the biophysical profile testing time and to reduce the number of non-reassuring tests. © 2005 Wiley Periodicals, Inc. J Clin Ultrasound33:223–225, 2005

Lorsqu'une hypoxemie prolongee est induite chez la brebis foetale suite a une reduction du debit sanguin uterin (RDSU), les mouvements respiratoires foetaux (MRF) diminuent d'abord pour revenir ensuite a la valeur normale. L'ethanol inhibe aussi les MRF. Ces experiences ont eu pour but de determiner le role de l'etat d'oxygenation foetale dans l'inhibition des MRF induite par l'ethanol. On a pense, pendant 1 h, 1 g d'ethanol/kg de poids corporel maternel a des animaux ayant ete soumis, pendant 20 h, a une RDSU (n = 9) ainsi qu'a des brebis foetales normoxemiques (n = 9), puis on examine l'effet sur les MRF, l'activite electrocorticale (ECoG) et l'activite electro-oculaire (EOG). Chez les foetus normoxemiques, la frequence des MRF a diminue de 26,1 ± 5,5% a 2,8 ± 1,6% (p < 0,05) en presence d'ethanol, pour retourner ensuite aux valeurs basales en 6 h ; chez les foetus RDSU, l'ethanol n'a eu aucun effet sur les MRF (32,8 ± 9,1%). L'ethanol a augmente l'activite ECoG intermediaire de 16,6 ± 2,9% a 49,0 ± 9,8% (p < 0,01) chez les foetus normoxemiques, mais il n'a eu aucun effet chez les foetus RDSU. Nous concluons que le ou les mecanismes adaptatifs impliques chez la brebis foetale durant une RDSU prolongee suppriment sa capacite de repondre a l'ethanol.

We have previously proposed a method to measure small displacements of internal tissue which is based on an ultrasonic pulsed Doppler technique. The Doppler frequency shift of the ultrasonic waves due to the tissue movement is detected using a modified quadrature detector, and the displacement of the internal tissue is estimated by using an arctangent method. Based on the algorithm, we have constructed a quantitative monitoring system for fetal breathing movement. The fetal breathing movement is a rhythmic movement of the fetal diaphragm and it is recorded as a nearly sinusoidal displacement with a repetition frequency from 0.5 Hz to 2 Hz. In this paper, an automated fetal breathing movement detection algorithm for the displacement data observed by using the small displacement measurement system is proposed. This method uses a modified autocorrelation technique for detecting the displacement due to the fetal breathing movement. The method is applied to five fetuses of late pregnancy and the result is compared with the manual detection.

In addition to his scientific contributions per se, and helping to inspire the small army of leaders to be that came of age under his tutelage, Geoffrey Dawes had a special and amazing gift for synthesizing information and ideas. Many of his overviews of various issues were given as invited lectures, keynote addresses, and introductions to various proceedings and conferences. For instance, in what was to be the first of several symposia devoted to the “baffling problem” of sudden infant death syndrome (SIDS), held in 1963 in Seattle, WA (Wedgwood and Benditt 1965), with his background in physiology and pharmacology, Dawes brought valuable insights to the discussion. In his presentation on cardiovascular pulmonary reflexes, he emphasized the relation of his studies with asphyxia in newborn and young lambs to the enigma of SIDS. Additionally, in terms of casual mechanisms, he stressed the necessity to consider alternative hypotheses (Dawes 1965). A decade later at a Bethesda, MD, symposium devoted to this topic (Bosma and Showacre 1975), Dawes participated in the discussion of almost half of the formal presentations. In concluding comments, he challenged the participants on their many assumptions and the supposed “facts” presented; “I would be careful about this evidence,” he cautioned (Dawes 1975, p. 266). Importantly, Dawes formulated a number of ideas relating to SIDS and outlined research questions that required exploration (Dawes 1975). Many of these remain unanswered to the present day (Kinney and Thach 2009). Along this line the hippocampus is a key component of the forebrain-limbic network that modulates respiratory regulation via interactions with brainstem neuronal centers. A provocative study has reported that a marker of hippocampus dentate gyrus abnormality, food granule cell bilamination, was present in 41% (47 of 114) of SIDS newborns whereas this abnormality was apparent in only 8% (3 of 39) controls (Kinney et al. 2015). This may serve as a morphologic marker for underlying brain vulnerability.