Fetal general movements and brain sonography in a population at risk for preterm birth
Received 2 December 2009; accepted 31 January 2010.
Abstract
Background
General movements (GMs) assessed three months post term are related to brain injury and neurological outcome.
Aims
To study GMs in fetuses and their predictive value for echogenicity changes in the fetal brain.
Study design
Prospective study of fetal GMs (classified as normal or abnormal) and echogenicity changes in the periventricular, basal ganglia/thalami area, and ventricular system (classified as absent, mild or moderate).
Subjects
121 fetuses from pregnancies affected by hypertensive disorders and/or preterm labour, at risk for preterm birth (26–34weeks gestational age).
Outcome measures
Prevalence of abnormal GMs, GM parameters (amplitude, speed and complexity), and moderate echogenicity changes in the fetal brain (periventricular ≥IB, intraventricular grade II/III, and basal ganglia/thalamus locally increased). Predictive values of GMs for clinical parameters and moderate echogenicity changes.
Results
GMs were abnormal in 58%, with amplitude affected in 96%, and speed and complexity in 59%. Abnormal GMs correlated with oligohydramnios (p=0.002) and hypertensive disorders (p=0.015). Echogenicity changes of the brain were absent, mild and moderate in 27%, 39% and 31%, respectively. The sensitivity of GMs for moderate echogenicity changes in the three areas combined was 0.65, and the periventricular area 0.85, specificity both 0.44, negative predictive values 0.73 and 0.96 respectively.
Conclusions
Qualitative abnormal GMs are frequent in fetuses of compromised pregnancies, and correlate with hypertensive disorders and oligohydramnios. The amplitude of GMs was most frequently affected. Abnormal GMs relate to moderate echogenicity changes especially in the periventricular area of the fetal brain, while normal GMs predict absence of moderate echogenicity changes.
aDepartment of Obstetrics and Gynaecology, Research Institute MOVE, VU University Medical Centre, Amsterdam, The Netherlands
bDepartment of Neonatology, Leiden University Medical Centre, Leiden, The Netherlands
cDepartment of Obstetrics and Gynaecology, Tygerberg Hospital, Stellenbosch University, South Africa
Corresponding author. Department of Obstetrics and Gynaecology, VU University Medical Centre, Post Box 7057, 1007MB Amsterdam, The Netherlands. Fax: +31 204441485.
ABSTRACT