Abstract
The prevalence of cerebral palsy has not decreased despite major improvements in clinical care in antenatal/ neonatal period as well as intrapartum period. In about 70% of cases, cerebral palsy results from events occurring before birth that can disrupt normal development of the brain. The antepartum risk factors should include fetal brain mal development and intrauterine brain injuries, which are unclassifiable into congenital brain anomalies and may exist inconspicuously during pregnancy and even after birth. Especially, neuronal migration disorder and acquired brain damage in utero should be responsible for postnatal neurological impairment. Imaging technologies including three dimensional ultrasound have been remarkably improved and contributed to prenatal evaluation of fetal Central Nervous System (CNS) development and assessment of CNS abnormalities in utero. In this article, objective and precise imaging diagnoses of fetal CNS including migration disorders and acquired brain damages. Furthermore, 3D bidirectional power Doppler angiography has depicted fine cerebral vessels of medullary veins which may relate with timing of insult as well as with postnatal neurological prognosis. It is promising to clarify the developmental mechanism of CNS damages with advanced ultrasound diagnostic techniques in the near future. Postnatal unexplained neurological deficits may strongly relate with intrauterine brain development therefore fetal neurology has great responsibility and an important role in perinatal medicine.
Highlights
In perinatal medicine, one of the most important roles is “to lessen the number of infants with neurological impairment
The Surveillance of Cerebral Palsy in Europe (SCPE) reported that the current prevalence of CP is similar in all six countries in the registry (2.12 to 2.45 per 1000 live births) as is the increasing trend in time from well below 2 per 1000 (1.7) live births in the 70’s to well above 2 per 1000 live births (2.4) in the 90’s [1]
The antepartum risk factors should include fetal brain maldevelopment and intrauterine brain injuries, which are unclassifiable into congenital brain anomalies and may exist inconspicuously during pregnancy and even after birth
Summary
One of the most important roles is “to lessen the number of infants with neurological impairment. The Surveillance of Cerebral Palsy in Europe (SCPE) reported that the current prevalence of CP is similar in all six countries in the registry (2.12 to 2.45 per 1000 live births) as is the increasing trend in time from well below 2 per 1000 (1.7) live births in the 70’s to well above 2 per 1000 live births (2.4) in the 90’s [1]. The SCPE reported that the proportion of low-birth weight infants among all children with CP is rising: 32% of all cases in 1966 and 50% in 1989. It is generally accepted that causes of cerebral palsy can be multiple and complex. These can include infection in the early part of pregnancy, oxygen deprivation to the brain, abnormal brain development, and restricted intrauterine growth. Multiple risk factors such as premature birth, multiple pregnancy, advanced maternal age, low birth weight have been considered
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