Intrauterine growth restriction and cerebral palsy

Abstract

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.

Keywords: neurological risk; pregnancies complicated with IUGR.

Figure 1

A sequence of images of the fetus in the 3rd trimester recorded by 3D/4D sonography, exhibiting smiling movements.

Figure 2

3D surface rendering mode of the different fetal facial expressions in the third trimester. This ultrasound mode enables the investigation of behavioural fetal facial expression.

Figure 3

Neonatal signs indicating a prenatal insult (sketch pictures) and comparison with 3D-US imagingin utero. (1) High-arched palate (left) and 3D-US imaging of the entire oral cavity(right); (2) Cortical thumb in a clenched fist (left) and 3D-US imaging of the normal and abnormal hand position. (3) Cranial ridges on every suture (left) and 3D-US imaging of the normal cranial suture in utero.