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An extensive review of the literature on the diagnostic and clinical accuracy of Kurjak’s antenatal neurodevelopmental test (KANET) and the summarized results of the multi-center study involving 10 centers revealed that four-dimensional ultrasonography (4D US) has become a powerful tool and KANET a valuable test that empowers the clinicians worldwide to evaluate the fetal behavior in a systematic way and contribute to the detection of fetuses that might be at high risk for neurological impairments and in particular cerebral palsy (CP). After 10 years of clinical use, many published papers and multi-center studies, hundreds of trained physicians and numerous tests performed all over the world, KANET has proven its value and has been showing encouraging results so far. The aim of this paper is to show the results from the studies done so far and to reveal the clinical value of the KANET. We expect that data from the larger ongoing collaborative study, the short- and long-term postnatal follow-up will continue to improve our knowledge. Ultimately, we all strive to prevent the CP disorders, autism spectrum disorder (ASD) and other neurological impairments and we are convinced that KANET might be helpful in the realization of this important aim.

In this article, we review a 4-year experience (2009-2013) with a Postgraduate Fellowship Program in Advanced obstetrics and gynecology Ultrasound under the Academic Mentorship of Dubrovnik International University (DIU), Croatia. The fellowship was conducted in Dubai, Welcare Mediclinic Hospital, and an Academic Teaching Hospital of DIU. Since 2009, we completed four master diploma courses with 38 graduates from the Middle East, Africa and Asia. The concept of the fellowship program did not require internship in our institution and allowed postgraduate students to remain in their professional and private environment. Each fellowship lasted for one year, including six teaching modules of 9 days every other month. The modules consisted of lectures given by international faculty and handson in the hospital, in the field of ultrasound in obstetrics and gynecology. The number of participants was limited to twelve in one course. At the end of the fellowship, students had to pass a written, oral and practical examination and hand over a logbook of a minimum of 50 sonographic case documentations. We give detailed account of the fellowship program, medicolegal and administrative specifics, course-related problems and their solutions from the nursing perspective, and describe the organizational challenges. How to cite this article Kurjak A, Honemeyer U, Sungler P, Grobler D, John LN. Obstetrics and Gynecology Ultrasound Fellowship: Experience of Dubrovnik International University Fellowship Program in Dubai. Donald School J Ultrasound Obstet Gynecol 2014;8(1):52-59.

We are reporting the case of a 40 years old 2nd gravida, 1 para. At 26 weeks of the reported pregnancy, fetal movements stopped suddenly and almost completely within 24 hours. At 30w2d she was referred for Doppler scan and fetal biometry. In ultrasonography (US) normal morphology was seen. Biometry corresponded to 28w1d. Outstanding observation was the permanent immobility of the entire fetus in four-dimensional ultrasound (4D-US). We found during two US examinations an abnormal KANET test, the first at 30w2d with a score of 3 points, and the second at 31w4d, with a score of 4 points. Cardiotocography (CTG) demonstrated complete loss of variability and accelerations. The patient developed severe polyhydramnios at 33 weeks. After lower segment cesarean section (LSCS) because of breech position, the newborn required ventilation, and passed away after 5 days. How to cite this article Honemeyer U, Kasirsky J, Pour-Mirza A, Kurjak A. KANET Diagnosis of Fetal Akinesia Deformation Sequence at 30 Weeks. Donald School J Ultrasound Obstet Gynecol 2013;7(4):500-505.

Implantation of the zygote outside the uterine cavity occurs in 2% of all pregnancies. The rate of ectopic pregnancies has increased from 0.5% in 1970 to 2% today. The prevalence of ectopic pregnancy in all women presenting to an emergency department with first-trimester bleeding, lower abdominal pain or a combination of the two is between 6 and 16%. When diagnosis is made early, the product of conception can be removed safely by laparoscopic surgery and be submitted for histological examination. Tubal rupture is a complication of late diagnosed tubal pregnancy which is more difficult to treat conservatively and often indicates tubectomy or segmental resection. In 5 to 15% of treated ectopic pregnancy cases, remnant conception product parts are diagnosed and may require a final methotrexate (MTX) injection. Rare sites of ectopic pregnancy include interstitial, cervical, abdominal and cesarean scar pregnancies. Our manuscript reviews and illustrates the use of novel sonographic methods such as three-dimensional ultrasound, multiplanar view, in combination with color and power Doppler ultrasound, for early detection of ectopic tubal pregnancy and of other, rare locations of ectopic pregnancy. How to cite this article Honemeyer U, Alkatout I, Plavsic SK, Pour-Mirza A, Kurjak A. The Value of Color and Power Doppler in the Diagnosis of Ectopic Pregnancy. Donald School J Ultrasound Obstet Gynecol 2013;7(4):429-439.

Since, ultrasound was introduced as diagnostic tool in obstetrics and gynecology by Professor Ian Donald 6 decades ago, realtime imaging has become the most common sonographic technique used in obstetrics and gynecology. When uncertain findings on real-time gray scale during two-dimensional sonography require further evaluation, advanced techniques are often necessary. Such advanced techniques include color and power Doppler, three- and four-dimensional ultrasound and techniques of volume manipulation (rendering), such as surface and maximum mode, magic cut, volume calculation (VOCAL), NICHE mode, and -as latest innovation, HD flow (Doppler) and HD life surface rendering. The authors would like to illustrate by means of a series of images and case presentations, how these new diagnostic tools find their clinical application in the daily routine of care in obstetrics and gynecology. How to cite this article Honemeyer U, Kurjak A. Advanced Obstetrical and Gynecological Ultrasound: Imaging with New Technologies. Donald School J Ultrasound Obstet Gynecol 2013;7(1):51-65.

The fetal brain as focus of scientific interest could not emerge before the 20th century. This was only possible after a long history of parallel advances in the fields of anatomy, physiology, pathology and imaging techniques. Some of these are presented in this article. We are providing (1) a historical overview about ‘the brain in science’ in general, (2) a historic overview about fetal brain assessment and (3) an overview of the present and reflections about the future of fetal brain assessment. How to cite this article Honemeyer U, Saling E. Past, Present and Future of Fetal Brain Assessment. Donald School J Ultrasound Obstet Gynecol 2013;7(1):36-45.

Objectives: The aim of this study was to evaluate the clinical value of Kurjak’s Antenatal Neurodevelopmental Test (KANET), a new test for fetal neurodevelopment. Methods: One hundred seventeen prenatal neurological tests were performed by the KANET scoring system between 28 and 38 weeks of gestation in 24 low-risk (24 fetuses) and 26 at-risk pregnancies (32 fetuses). The study was completed within 12 months from July 2011 onward. All 56 babies were assessed for early neurological outcome at birth by neonatologists. Results: There were no abnormal KANET scores. Two thirds of all borderline scores were found in the at-risk group. Because KANET was performed more than once in most pregnancies, we introduced the average KANET score. Only one fetus of the “at-risk group” had a borderline average score. This fetus had the only abnormal early neurological outcome of all 56 fetuses. When we compared all 18 borderline KANET scores with fetal diurnal rhythm based on maternal observation, we found that 89% of the borderline scores of the “at-risk” group were at times characterized by the mother as usually “active” periods compared with 33.3% in the low-risk group. Conclusion: KANET is suggestive of expressing the risk for neurodevelopmental fetal disorders. Studies designed to investigate the potential connectivity of fetal diurnal rhythm and pregnancy risk status should follow.

We present a 39-year-old G0P0 with history of infertility treatment-caused ovarian hyperstimulation and uterine fibroids, who was found to have a rare pathological presentation. Peritoneal lesions were identified during laparoscopic treatment for this patient's fibroids. Histological evaluation of these lesions revealed leiomyomatosis peritonealis disseminata (LPD), also known as disseminated peritoneal leiomyomatosis. While LPD can often be confused for metastatic leiomyosarcoma due to the histological presence of fibroblasts, myofibroblasts, smooth muscle, collagen, and spindle cell appearance, cases of LPD are generally benign, and present no need for therapy in asymptomatic cases. We present a discussion based on the clinical and sonographic presentation of LPD, its pathophysiology, treatment options and prognosis. A question set has been designed to reinforce comprehension of this presentation and associated topics for health care professionals. How to cite this article Honemeyer U, Ross JR, Barnard JJ, Appleton K, Tullius TG Jr, Montgomery L, Plavsic SK. Recurrent Leiomyomatosis Peritonealis Disseminata: Sonographic and Laparoscopic Correlation. Donald School J Ultrasound Obstet Gynecol 2012;6(3):327-332.

A significant proportion of fetal anomalies are surgically correctable. Their accurate and reliable prenatal diagnosis is of great importance, and will have significant influence on both postnatal and postsurgical outcome. The influence of prenatal diagnosis of simple structural defects will interfere with organ development. In the light of recent achievements, traditional teratology has to be reexamined more critically. How to cite this article Zaputovic S, Stanojevic M, Honemeyer U, Turudic T, Kurjak A. Surgically Correctable Fetal Anomalies: Ultrasound Diagnosis and Management. Donald School J Ultrasound Obstet Gynecol 2012;6(3):237-256.

Trophoblastic diseases are mainly hydatidiform mole and choriocarcinoma, where the latter is usually the sequela of molar pregnancy and malignant systemic disease with general metastases destructing various tissues and organs till she die. High level urinary hCG, real-time B-mode and color Doppler imaging detect hydatidiform mole in early gestation, postmolar persistent trophoblastic disease is diagnosed by urinary hCG, and treated by prophylactic chemotherapy against choriocarcinoma. Uterine choriocarcinoma and its metastases are diagnosed by hCG and B-mode, color and power Doppler and 3D images detecting rich tumor blood flow. Most choriocarcinoma was effectively treated by primary chemotherapy with methotrexate, etoposide, etc. Until complete remission where hCG is lower than the cut-off level. Placental site trophoblastic tumor (PSTT) and epitheloid trophoblastic tumor (ETT) were low in hCG level and high in human placental lactogen (hPL), and show rich tumor blood flow in color Doppler ultrsound. Nongestational choriocarcinoma is rare and usually chemotherapy resistant. How to cite this article Maeda K, Kurjak A, Varga G, Honemeyer U. Trophoblastic Diseases. Donald School J Ultrasound Obstet Gynecol 2012;6(1):27-42.

Observation of the fetus in vivo by four-dimensional ultrasound provided abundant material for experimental studies of early neurobehavioral development. Consequently, a new scoring system for fetal neurobehavior, KANET, was created as a standardized, practical and reproducible method for qualitative and quantitative analysis of characteristics of fetal movement patterns. The eight parameters of KANET not only allow a differentiated comparison of fetal behavioral states but also enable prenatal diagnosis of abnormal neurological development. The knowledge that individual temperament is expressed by movement patterns is not new. To find answers to the question when temperament formation might begin, we applied KANET simultaneously at different gestational ages to both fetuses of a dichorionic twin pregnancy, and compared the results with temperament evaluation of both neonates 8 weeks postpartum. How to cite this article Honemeyer U, Kurjak A. Prenatal Beginnings of Temperament Formation–Myth or Reality? Case Study of a Twin Pregnancy. Donald School J Ultrasound Obstet Gynecol 2012;6(2):148-153.

Objective of the study was to assess the possible effect of maternal fever without clinical chorioamnionitis on fetal behavior. In a period of 18 months, in a prospective longitudinal cohort study, Kurjak antenatal neurological test (KANET) was applied to assess fetal behavior in both normal pregnancies and pregnancies complicated by maternal fever. According to the primary localization of the infection, maternal fever group was divided into four groups: Respiratory tract infection, urinary tract infection, malaria and gastrointestinal tract infection. According to KANET test, fetuses with scores >14 were considered normal, 6 to 13 borderline and abnormal, if KANET scores were How to cite this article Talic A, Kurjak A, Honemeyer U. Effect of Maternal Fever on Fetal Behavior Assessed by KANET Test. Donald School J Ultrasound Obstet Gynecol 2012;6(2):160-165.

The first trimester, mostly defined as the first 100 days of pregnancy, is characterized by many important landmarks heralding the ultimate outcome of pregnancy. Woman becomes aware of her pregnancy after missing her period, being already two weeks postconception at that time. A positive pregnancy test opens Pandora's Box, raising more questions than giving answers. Although a positive pregnancy test most likely suggests an intrauterine pregnancy, production of human chorionic gonadotropin (hCG) occurs as well in tumors (dysgerminoma, choriocarcinoma) or maldeveloped pregnancies, such as ectopic pregnancy, blighted ovum or mola hydatidosa. Other early pregnancy complications and failures, like subchorionic hematoma, missed abortion, incomplete miscarriage, retained products of conception, are likely to be accompanied by clinical symptoms such as lower abdominal pain and/or vaginal bleeding, and suboptimal beta hCG serum levels. Transvaginal ultrasound probes with frequencies of up to 14 MHz have lowered the threshold for US-detection of intrauterine pregnancy to 1200 mIu/ml beta hCG/serum (discriminatory zone), and enable identification of all above-mentioned 1st trimester pregnancy disorders earlier than ever before. Furthermore, the additional interrogation of the region of interest (ROI) with color Doppler (CD) and pulsed-wave Doppler (PW) supplies important information about characteristics of vascularization and flow indices, which assists in further differentiation and prognosis of abnormal early pregnancy findings. With the introduction of transvaginal three-dimensional (3D) sonography, and real-time 3D ultrasound (4D), in vivo studies of the early fetal life became possible. The developmental progress of the embryo and early fetus, its anatomy, and first movement patterns, have been explored by means of ultrasonic 3- and 4D imaging, which can be considered as nonteratogenic as long as investigators adhere to certain safety rules. The new field of sonoembryology has emerged, and researchers are penetrating the mists hiding the beginning of human life. Another area of remarkable expansion has been the 1st trimester scan between 11 and 13/6 weeks of gestation. It includes not only the early diagnose of fetal structural anomalies, like acranius-anencephalus sequence, and the screening for fetal aneuploidies such as trisomia 21,18 and 13, but also offers likelihood ratios for hypertensive pregnancy disorders (pre-eclampsia) and intrauterine growth restriction (IUGR).

Colorectal cancer (CRC) is the fourth most common cancer in men and the third most common cancer in women worldwide. The recent decline of CRC in the USA has been attributed to successful development of screening programs. In the last 20 years, endorectal ultrasound (ERUS) has become the primary method for locoregional staging of rectal cancer. Transvaginal sonography (TVS), with a high-frequency probe, obtains excellent image resolution of deep pelvic organs. TVS not only enables diagnosis and treatment in gynecology, infertility, and early pregnancy but also has the potential to detect other structural abnormalities within its reach, such as neoplasm of the rectosigmoid. Three-dimensional power Doppler ultrasound (3D PD) can depict the morphology of the vessel tree of tumors, and thus help to discriminate between benign and malignant neoplasm. In this case of a 42-year-old patient, an adnexal mass was diagnosed by TVS. Three-dimensional ultrasound gave topographic evidence of sigmoid colon tumor. Spectral Doppler and 3D PD diagnostic criteria of tumor vasculature, demonstrated in this neoplasm, were highly suspicious of malignancy. TVS diagnosis initiated endoscopic histological verification of adenocarcinoma of the sigma and timely surgical intervention.

In developed countries more women die annually from ovarian cancer than from all other gynecologic malignancies combined. The fact that the ovaries are deep within the pelvic cavity and difficult to palpate is an obstacle to early diagnosis, especially in peri-post menopausal women, the group with the highest incidence of the disease. Seventy percent of patients are not diagnosed with the disease until the cancer has metastasized beyond the ovaries and is at stage 3 or 4. Patients with stage 3 or 4 have a 5-year survival rate of only 20-30%. Given the burden of suffering associated with ovarian cancer and the clear survival gradient related to the stage of disease at diagnosis, there is great need for development of effective screening methods for early detection of epithelial ovarian cancer. Better understanding of ovarian cancer etiology and increasing knowledge of tumor biology have both contributed to identify efficient Serum Tumor Markers, to screen high-risk populations. Technical advances in the field of ultrasound made transvaginal sonography (TVS) become the most important diagnostic tool, and multimodal (Serum markers plus TVS) screening appears to be a diagnostic break-through in fighting ovarian cancer. Five case reports illustrate that new ultrasound technologies such as 3D volume acquisition and 3D power Doppler imaging promise more reliable identification of an abnormal ovarian tumor vascularity and tumor-typical vascular architecture, thus facilitating early stage 1 – detection of the disease.

Three-dimensional, multiplanar sonography, using a volume data set acquired with a 3D probe, has revolutionized ultrasonographic imaging and takes sonographers to a new perception of the fetus in 3 dimensions. Real time scanning, until the late nineties only possible in B-mode, can now be performed in 3D with up to 40 frames/sec. Fetal neurology emerged as a new perinatal research field with the 4D visualization of fetal behavior. Doppler ultrasound, diversified and refined from continuous wave and pulsed Doppler to Color – and Power Doppler, when added to 3D sonography, creates fascinating options of noninvasive fetal vascular mapping (sonoangiography) and vascular assessment of placenta. The diagnostic and demonstrative potential of an acquired 3D volume data set can be maxed with the help of postprocessing and rendering software. After storage, the evaluation of fetal 3D data sets can happen without the patient, with the option of specialist consultation, using telemedicine. In the article, the new 3D “modes” like surface rendering, maximum mode, 3D Color and Power Doppler, STIC, volume rendering, and glass body rendering, are described and illustrated in their display of normal fetal anatomy.

Diagnosis of uterine ectopic pregnancy of interstitial or cervical location poses a challenge to the sonographer to assess the exact locationand determine the best treatment option.In the presented case, gray scale ultrasound raised the suspicion of cornual pregnancy. Color Doppler and Pulsed Doppler waveformanalysis has identified the typical peritrophoblastic flow. Three-dimensional (3D) ultrasound enabled navigation through multiplanar sectionsof the uterus and has finally confirmed the diagnosis of interstitial pregnancy.Due to high human chorionic gonadotropin (hCG) levels, viability of the pregnancy, and impending rupture laparoscopic cornual resectionwas chosen among different treatment options.

Cerebral palsy (CP) is the most common motor disability in childhood. It affects 2 to 2.5 children in 1000 live-births, with 20 to 30 fold increased prevalence in preterm infants. Despite of progress in perinatal care, the prevalence of cerebral palsy did not change in the last 50 years. New knowledge about etiological factors, such as inflammation, elevated level of cytokines, vascular strokes and genetic factors shift the origin of cerebral palsy mostly into antenatal period, making intrapartal damage responsible for less than 10% of cases. CP is becoming increasingly the subject of interdisciplinary research. Fetal neurosonography with a growing number of studies promises better understanding of the normal functional maturation of the human brain which may lead to effective prevention and treatment of cerebral palsy. Advances in 4D ultrasound resulted in development of KANET as tool for detection of abnormal fetal behavior.

Intrauterine growth restriction (IUGR) can be described as condition in which fetus fails to reach his potential growth. It is common diagnosis in obstetrics, and carries an increased risk of perinatal mortality and morbidity. Moreover, IUGR has lifelong implications on health, especially on neurological outcome. There is a need for additional neurological assessment during monitoring of fetal well-being, in order to better predict antenatally which fetuses are at risk for adverse neurological outcome. Studies have revealed that the behavior of the fetus reflects the maturational processes of the central nervous system (CNS). Hence, ultrasound investigation of the fetal behavior can give us insight into the integrity and functioning of the fetal CNS. Furthermore, investigations carried out using modern method, four-dimensional (4D) sonography, have produced invaluable details of fetal behavior and its development, opening the door to a better understanding of the prenatal functional development of the CNS. Based on previous observations and several years of investigation, our reaserch group has proposed a new scoring system for the assessment of fetal neurological status by 4D sonography named Kurjak antenatal neurodevelopmental test (KANET). The value of KANET in distinguishing fetal brain and neurodevelopmental alterations due to the early brain impairment in utero is yet to be assessed in large population studies. However, preliminary results are very encouraging.

Recent development of three-dimensional (3D) and four-dimensional ultrasound (4D) provided us with new possibilities to study fetal movements and behavior. Many studies have been conducted in order to provide information on specific movement pattern appearance in normal and high-risk fetus. This was the base for multicenter study on use of new scoring system for fetal neurobehavior which purpose is to recognize fetuses with increased risk for poor neurological outcome. The purpose of this paper is to give brief review on the use of 3D and 4D ultrasound in the assessment of fetal behavior. Objectives Define possibilities to study fetal movements and behavior by 3D and 4D ultrasound Decribe new scoring system for neurobehavior in fetuses with increased risk for poor neurological outcome Summarize behavioral perinatology research and potential clinical applications

Adnexal masses have an etiological spectrum ranging from gynecologic to non-gynecologic causes. Because they can be benign or malignant, their evaluation has to include a careful analysis of the patients history, a physical examination, and laboratory and imaging tests. Transvaginal ultrasonography remains the standard for evaluation of adnexal masses. Findings suggestive of malignancy in an adnexal mass include a solid component or intracystic proliferations, thick septations (greater than 2 to 3 mm), bilateral occurrence, blood flow within the solid component of the mass, and presence of ascites. Tumor-neoangiogenesis has typical features of flow pattern and vascular architecture, indicative of malignancy, which can be visualized by Doppler ultrasound. Power Doppler with its increased sensitivity for slow flow and small vessels is ideal for this purpose and, in combination with acquisition of a volume data set of the region of interest (RoI), gives new insights in tumor angiology and appears to be an additional diagnostic tool. An important predictor of malignancy is a resistance index (RI) below 0.42 in arterial tumor vessels. 3D rendering modes like magic cut, NICHE mode, power Doppler glass body rendering, can make valuable contributions to differential diagnose of adnexal masses. A variety of adnexal masses is illustrated in their specific sonographic appearance, with special regard to ovarian carcinoma.

The evaluation of adnexal masses based on transvaginal sonography (TVS) and when their size is too big- transabdominal US can be facilitated and refined by using color Doppler (CD), power Doppler (PD), and pulsed Doppler(PW), including three-dimensional ultrasound (3D US). With these modes, we obtain information about vascularity and flow indices, and their distribution within a mass. Considering the fact that neoangiogenesis is a main feature of malignancy, this is essential information. Thus, we are able to assume the benign or malignant character of an adnexal mass, make the right choice of additional imaging or biochemical tests, and then channel the treatment appropriately. This is subsequently demonstrated for simple cyst, hemorrhagic cysts, endometrioma, dermoid, serous papillary cystoma, ectopic pregnancy, and ovarian carcinoma. Abnormal uterine bleeding (AUB) is a common problem in primary care. Compared to transabdominal approach, TVS improves the detection rate of underlying uterine pathology. In conditions like endometrial hyperplasia, polyps, submucous leiomyoma, and endometrial cancer, CD, PD, PW and contrast enhanced transvaginal ultrasound may optimize sonographic evaluation. Saline infusion sonohysterography (SISH) in out patient department (OPD) is an alternative to invasive diagnostic hysteroscopy in patients with AUB. Care for maternal and fetal well-being during pregnancy is a main task in OPD. The assessment of fetal pathology is almost entirely based on Ultrasound. Several illustrations of fetal anomalies detected during 1st trimester and 2nd trimester screening, of abnormal findings in feto-maternal Doppler ultrasound, and fetal pathology demonstrated in 3D/4D ultrasound mode, conclude this review of advanced ultrasound in primary care.

Implantation of the zygote outside the uterine cavity occurs in 2% of all pregnancies. The product of conception can be removed safely by laparoscopic surgery and be submitted for histological examination. The rate of ectopic pregnancies has increased from 0.5% in 1970 to 2% today. The prevalence of ectopic pregnancy in all women presenting to an emergency department with first-trimester bleeding, lower abdominal pain, or a combination of the 2 is between 6% and 16%. DESIGNATION: Workup of all localizations of ectopic pregnancies at a university department of obstetrics and gynecology.Comparison of diagnostic and therapeutic modalities from the surgical laparoscopic approach to nonsurgical, medical options.Tubal pregnancies: (1) to preserve tubal function, salpingotomy, partial salpingectomy followed by laparoscopic anastomosis, or fimbrial milking is performed. (2) Tubectomy or salpingectomy is performed only in severely damaged or ruptured tubes or if the patient does not desire further pregnancies. Nontubal ectopic pregnancies (ovarian pregnancy, ectopic abdominal pregnancy, interstitial or cornual pregnancy/rudimentary horn, intraligamental and cervical pregnancies) all require their own specific treatment.The predominant drug is methotrexate, but other systemic drugs, such as actinomycin D, prostaglandins, and RU 486, can also be applied.Tubal rupture is a complication of late diagnosed tubal pregnancy that is more difficult to treat conservatively and often indicates tubectomy or segmental resection. In 5% to 15% of treated ectopic pregnancy cases, remnant conception product parts may require a final methotrexate injection.This article is a review to aid clinical diagnosis of ectopic pregnancies that now can be diagnosed earlier and treated effectively by laparoscopic surgery.

To assess differences in fetal behavior in both normal fetuses and fetuses with cerebral ventriculomegaly (VM).In a period of eighteen months, in a longitudinal prospective cohort study, Kurjak Antenatal NeuorogicalTest (KANET) was applied to assess fetal behavior in both normal pregnancies and pregnancies with cerebral VM using four-dimensional ultrasound (4D US). According to the degree of enlargement of the ventricles, VM was divided into three groups: mild, moderate and severe. Moreover fetuses with isolated VM were separated from those with additional abnormalities. According to the KANET, fetuses with scores ≥ 14 were considered normal, those with scores 6-13 borderline and abnormal if the score was ≤ 5. Differences between two groups were examined by Fisher's exact test. Differences within the subgroups were examined by Kruskal-Wallis test and contingency table test.KANET scores in normal pregnancies and pregnancies with VM showed statistically significant differences. Most of the abnormal KANET scores as well as most of the borderline-scores were found among the fetuses with severe VM associated with additional abnormalities. There were no statistically significant differences between the control group and the groups with isolated and mild and /or moderate VM.Evaluation of the fetal behavior in fetuses with cerebral VM using KANET test has the potential to detect fetuses with abnormal behavior, and to add the dimension of CNS function to the morphological criteria of VM. Long-term postnatal neurodevelopmental follow-up should confirm the data from prenatal investigation of fetal behavior.