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Assessment of motoric and hemodynamic parameters in growth restricted fetuses

INTRODUCTION: Intrauterine growth restriction (IUGR) has lifelong implications on neurologic outcome. One of the major causes of IUGR is placental insufficiency, which leads to inadequate nutritive and oxygen supply of the fetus. The most important adaptive reaction responsible for maintaining fetal homeostasis during hypoxia is fetal cardiovascular response, including the redistribution of cardiac output primarily towards the fetal brain. Our data have revealed that severe brain damage can develop despite increased brain perfusion. There is currently no direct method for assessment of the fetal central nervous system functions, though it is believed that fetal behavior reflects brain development. Fetal behavior could be described as fetal motor activities observed by ultrasonography. Our aim is to get better insight into fetal brain function and to predict antenatally which IUGR fetuses are at risk for adverse neurologic outcome by combining motoric and hemodynamic parameters. MATERIAL AND METHODS: Study includes motor assessment of the IUGR fetuses using new test KANET and evaluation of the hemodynamic parameters, followed by neurological monitoring of children during 24 postnatal months, when diagnosis of severe form of cerebral palsy can be confirmed or excluded. KANET is based on four- dimensional sonography and evaluates certain movements between 20 and 40 weeks of pregnancy. Further, changes in the fetoplacental hemodynamics will be quantified by the cerebroumbilical ratio. RESULTS: So far, results on 6 cases demonstrate the ability of KANET in recognizing pathologic behavior in IUGR fetuses with severe hemodynamic disorders. It was also noted that not all fetuses with abnormal hemodynamic findings have pathologic behavior. CONCLUSIONS: Further studies are needed to show what is the relationship of motor and hemodynamic parameters in IUGR fetuses. Considering that not all fetuses with abnormal hemodynamic findings have pathological behavior it is possible that KANET score represents independent factor in predicting neurologic development of the child.

IUGR; hypoxia; fetal doppler; four dimensional ultrasound; brain development

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