Fetal Body Movements Research Articles

Hypoglycaemia in pregnancy

Normally there is a very close relationship between maternal and fetal glucose concentrations during both early and late gestation. Maternal hypoglycaemia during pregnancy will therefore not only affect the mother herself but also the conceptus. As can be judged from the literature, acute hypoglycaemic episodes are only rarely seen in non-diabetic pregnancies. In recent years it has become increasingly evident that insulin-dependent diabetic patients, whether pregnant or not, run a much increased risk of having severe hypoglycaemia (SH) attacks (i.e. the patient needs the assistance of another person to relieve the attack) whenever attempts are made to introduce tight blood glucose control. Very high incidence rates of SH between 19% and 44% have been reported in diabetic pregnancy. Episodes of SH could have serious consequences; neuroglycopenia seems especially hazardous for the mother particularly during the performance of a critical task like driving a car. While hypoglycaemia has embryopathic effects in rodents, there are no data in the human to support a teratogenic effect. Insulin-induced hypoglycaemia in the last trimester of diabetic pregnancy may increase fetal body movement and decrease the fetal heart rate variability. A number of very rare conditions such as insulinoma, severe malaria, HELLP syndrome (haemolysis, elevated liver enzymes, low platelet count), severe fulminating liver disease, and ACTH and/or growth hormone deficiency have been reported to be associated with SH. Relative hypoglycaemia--i.e. low fasting blood glucose and 'flat' glucose tolerance test--is frequently seen in normotensive pregnant women with intrauterine fetal growth retardation. This pattern of maternal carbohydrate metabolism could lead to fetal hypoglycaemia and hypoinsulinaemia and contribute to poor fetal growth.

Observations of intrapartum fetal activities

The objective of this observational study was to document the frequency of biophysical activities such as breathing and body movements during spontaneous labor in the low-risk, term fetus. The fetuses of truly low-risk patients without medication during labor were observed serially with real-time ultrasonography for fetal breathing or body movements for a maximum scanning time of 1 hour. Fetal breathing movements, hiccups, and fetal body movements were recorded, as were cervical dilatation, status of the fetal membranes, and Apgar scores. Fetal breathing activity was recorded in 76% of fetuses in early labor and 90% in advanced labor. Fetal body movements were present during 85% of the observations. All babies had 5-minute Apgar scores > 7. Ultrasonographic evaluation of fetal breathing and body movements during spontaneous labor was associated with normal birth outcome in this low-risk population. The clinical utility of this noninvasive method in determining intrapartum fetal health remains to be tested in an unselected population.

A Cost Analysis of Ambulatory Antenatal Testing in a Tertiary Care Center

The purpose of this reprospective study was to determine the cost of antenatal testing in an ambulatory setting for the most common indications for testing. A cost analysis based on abnormal test results leading to intervention to deliver was done for the various high risk indications. The population consisted of 467 high risk patients who were divided into five categories based on the indications for testing: Postdate pregnancy, risk for Uteroplacental Insufficiency, Diabetes, Twins, and Other. The cost to detect one patient with an abnormal test for a marker utilizing fetal heart rate, breathing movement, body movement, and tone was $13,536. For the marker oligohydramnios, the cost was $2,707. Significant differences in cost were noted among each of the five groups within the study population. Future studies of antenatal fetal surveillance should consider the cost of testing and attempt to direct a specific patient to the most appropriate test to enhance utilization of resources.

Periods of Activity and Inactivity in the 12-to 16-Week Fetus

Active and inactive periods in four 12-to 16-week low risk human fetuses were studies. These periods are interpreted as precursors to the state parameter of fetal body movements. Adequate reliability on scoring videotapes of fetal activity and inactivity was achieved, but extensive training with explicit protocols was required. Results suggested that there was an increase in among of fetal movement form 12 to 14 weeks, followed by a significant decrease in movement from 14 to 16 weeks. There was a significant increase in cycles per minute from 12 to 16 weeks. Early fetal movement was descriptively compared to newborn infant movement using a Brazelton Neonatal Behavioral Assessment Scale.

The effect of tocolytic agents (indomethacin and terbutaline) on fetal breathing and body movements: A prospective, randomized, double-blind, placebo-controlled clinical trial

OBJECTIVE: The null hypothesis of this study is that maternal administration of indomethacin orterbutaline will not affect fetal breathing and body movements. STUDY DESIGN: Thirty patients with a low-risk pregnancy, gestational age 26 to 32 weeks, and no signsof preterm labor were randomly assigned to receive either terbutaline (5 mg), indomethacin (50 mg), or a placebo. Ultrasonographic evaluation of fetal breathing and body movements was performed for 1 hour before and 1 hour after treatment. The total amount of time of fetal breathing and body movements in each group was subject to statistical analysis that included analysis of variance and covariance and a multiple comparison procedure. RESULTS: Indomethacin increased fetal breathing from 20.8 ± 13.1 minutes to 42.2 ± 14.8 minutes( p < 0.01), whereas terbutaline increased fetal breathing movements from 19.8 ± 9.0 minutes to 35.2 ± 12.4 minutes ( p < 0.01). No significant treatment effect was detected on fetal body movements. CONCLUSION: Between 26 and 32 weeks' gestation, a single dosage of indomethacin or terbutalineincreases fetal breathing movements by 103% and 78%, respectively. ( Am J Obstet Gynecol 1992;167:1059–63.)

Characterization of fetal body movement recorded by the Hewlett-Packard M-1350-A fetal monitor

The purpose of this study was to evaluate the ability of a commercially available monitor, the Hewlett-Packard M-1350-A fetal monitor, to record and discriminate between various fetal body movements. Twenty-four patients between 29 and 42 weeks' gestation were monitored over a 20 to 30 minute period simultaneously by the Hewlett-Packard instrument and ultrasonography. All 593 single or clustered fetal movements recorded by the monitor were seen ultrasonographically as being extremity movements that were either isolated or combined with trunk motion. Discriminating between these two types of movements was not possible on the basis of the duration of recorded movements. All adequate fetal heart rate accelerations were attributed to combined trunk and extremity movements. Detection of fetal hiccups was less exact, and recording of fetal hand, mouth, breathing, and rapid eye movements was beyond the sensitivity of the monitor. Signal artifacts were attributable to either motion of the maternal abdomen or Doppler transducer and became less of a problem with experience. Fetal extremity movements were recorded with accuracy by this new fetal monitor.

Fetal behavioral states: pathological alteration with hypoxia.

T he effect of hypoxia on fetal behavioral state is of particular interest to clinical obstetricians as well as physiologists. Fetal behavioral activity such as fetal breathing movements (FBM) and body movements, as well as certain heart rate patterns, can be readily identified in the human fetus, giving rise to their widespread use in the assessment of fetal health.’ An understanding of the mechanisms underlying the effect of hypoxia on fetal behavior, on the other hand, provides important clues to scientists interested in determining the physiology or basic mechanisms that regulate normal fetal activity patterns. This review will concentrate largely on the known effects of hypoxia on specific fetal behaviors that are integral to the determination of fetal “state” in both the human and sheep fetus.

Ultrasound evaluation of fetuses of zinc-deprived monkeys (Macaca mulatta)

Fetal body movements were studied in three groups of gravid rhesus macaques fed different amounts of dietary zinc (100 micrograms Zn/g diet, control, n = 12; 4 micrograms Zn/g diet, marginal deprivation, n = 7; 2 micrograms Zn/g diet, moderate deprivation, n = 11). Sonographic examinations were conducted during the third trimester in awake chair-restrained dams. Movement categories, derived from the human biophysical profile, were motor activity (trunk and limb movements), startle, and breathing movements. Moderately deprived fetuses were more active than controls on gestational day (GD) 115; maternal plasma zinc concentrations were significantly correlated with fetal activity at this time. In addition moderately deprived fetuses exhibited fewer breathing episodes on GDs 115-135. Biometrics measures indicated growth retardation in one moderately deprived fetus. These data suggest that moderate, but not marginal, dietary zinc deprivation influences fetal status as evaluated by sonography.

356 the Effect of Tocolytic Agents (Indomethacin and Terbutaline) on Fetal Breathing (FBM) and Body Movements (FM): A Prospective, Randomized, Double Blind, Placebo-Controlled Clinical Trial

356 the Effect of Tocolytic Agents (Indomethacin and Terbutaline) on Fetal Breathing (FBM) and Body Movements (FM): A Prospective, Randomized, Double Blind, Placebo-Controlled Clinical Trial

The effects of maternal hyperoxia on fetal breathing movements, body movements and heart rate variation in growth retarded fetuses

In hypoxemic intrauterine growth-retarded fetuses (IUGR) there is a reduction in the incidence of fetal movements and in fetal heart rate variation. A causal relationship with the impairment of fetal oxygenation has been suggested. In 16 IUGR fetuses and in 13 normally grown fetuses maternal hyperoxygenation was applied for 40 min to increase fetal P O 2 levels. All IUGR fetuses had abnormal Doppler blood velocity waveforms of the umbilical artery suggesting an impaired uteroplacental exchange. The effect of hyperoxygenation on fetal breathing and body movements and on fetal heart rate was evaluated. In the IUGR fetuses there was a significant increase in fetal breathing and body movements and in heart rate variation during hyperoxygenation as compared to the preceding control period of 40 min. No significant changes in fetal breathing and body movements were found in the normally grown control fetuses. A surprising observation was the increase of the number of heart rate decelerations after discontinuation of the maternal hyperoxygenation. It is concluded that in IUGR fetuses the increase in fetal heart rate variation and the increase in the incidence of breathing and body movements during maternal hyperoxygenation substantiates the relationship between these variables and the oxygenation status of the fetus.

Fetal Rest-Activity Cycles and Chronic Exposure to Antiepileptic Drugs

Rest-activity patterns were studied in fetuses exposed to antiepileptic drugs (AEDs) and in control fetuses at three intervals during pregnancy: 20, 32, and 38 weeks. At 20 weeks, periods of rest and activity were distinguished on the basis of fetal motility. Trunk, head, and arm movements were totaled. Periods of absence of movements for greater than 3 min were found in 20 of 31 recordings from AED-exposed fetuses compared with 11 of 20 recordings from controls (p greater than 0.05). The duration of these periods of inactivity did not differ significantly between the two groups. At 32 and 38 weeks, information on fetal motility and fetal heart rate (FHR) were combined to recognize rest-activity patterns according to the fetal behavioral state concept. At 32 weeks, three true fetal behavioral states were found for the study group, while there were none in the control group. Coincidence 1F through 4F occurred significantly less frequently at 32 weeks than at 38 weeks, regardless of whether fetuses were AED-exposed or not: 59% vs. 82% for the study group and 59% vs. 80% for the controls. At 38 weeks, true fetal behavioral states appeared in 20 of 34 fetuses exposed to AEDs and in 17 of 35 controls (p greater than 0.05). The sequence in which parameters changed within state transitions was found to follow the same preferred pattern in both groups. For transitions from behavioral state 1F (quiet sleep) into 2F (active sleep) the FHR pattern changed significantly earlier than fetal body or eye movements, while for the reverse transitions the FHR pattern changed significantly later (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Relationship between fetal biophysical activities and umbilical cord blood gas values

In a prospective study of 62 patients undergoing cesarean section before the onset of labor a fetal biophysical profile assessment was performed within 3 hours before the cesarean section. The presence or absence of the individual fetal biophysical activities (fetal heart rate reactivity, fetal breathing movements, fetal body movements, and fetal tone) were correlated with umbilical cord blood gas and acid-base measurements (artery and vein). Fetuses with nonreactive nonstress test results or the absence of breathing had significantly lower cord artery pH 1 P0 2 bicarbonate, and base excess measurements but not a significantly different PC0 2 level as compared with fetuses that had these activities present. Fetuses with the absence of movements or tone had lower pH 1 P0 2 bicarbonate, and base excess levels and higher PC0 2 levels as compared with fetuses with the presence of movements or tone, respectively. These blood gas and acid-base differences were observed in both umbilical cord artery and vein. Subsequent analysis of the blood gas and acid-base measurements of the fetuses with compromised biophysical activities revealed that there are different levels of acidemia, hypoxemia, and hypercapnia at which the individual biophysical activities are compromised. These data suggest that the first manifestations of fetal hypoxemia and acidemia are nonreactive nonstress test results and loss of fetal breathing; in advanced acidemia, hypoxemia, and hypercapnia fetal movements and fetal tone are compromised.

振動音刺激に対する胎児応答に関する研究

Effects of a 5-second external vibratory acoustic stimulation (VAS, 500 Hz, 75 db) were studied in 155 healthy pregnant women from 34 to 41 weeks' gestational age on the fetal heart rate and gross fetal body movement. Fetal behavioral states were also studied in 88 out of the 155 patients. The following results and conclusions were obtained. 1) VAS induced significant increases in the fetal heart rate baseline, the mean amplitude, the mean duration, and the mean time spent % of fetal heart rate accelerations and gross fetal body movements. 2) VSA induced significant changes in fetal behavioral states at states 1F and 3F, but no changes in states 2F and 4F. 3) Reaction to VAS was recognized also in the low birth weight (less than 2,500 g) group, but the duration of the reaction was shorter than that in the normal (greater than or equal to 2,500 g) group. 4) By lowering the incidence of false non reactive NST with VAS test, it was possible to predict the fetal prognosis better than NST alone. 5) Inasmuch as VAS changed the fetal behavioral state from resting phase to active phase, the use of VAS in addition to NST was very helpful in more accurate understanding of fetal heart rate monitoring.

Longitudinal assessment of behavioural transitions in healthy human fetuses during the third trimester of pregnancy

A longitudinal study was performed on 35 healthy fetuses in order to evaluate the developmental course of behavioural transitions during the last trimester of pregnancy. A progressive decrease in the duration of transitions as a function of gestational age was evidenced for both transitions from 1F to 2F and transitions from 2F to 1F. Concerning the sequence in change of behavioural variables (fetal heart rate, fetal eye movements and fetal gross body movements) a random distribution was found until 30 weeks for 1F to 2F transitions and until 34 weeks for 2F-1F transitions. After these gestational ages fetal heart rate and fetal gross body movements respectively become the first variable to change during 1F-2F and 2F-1F transitions. Reference values for these parameters are calculated in order to provide a basis for the diagnosis of behavioural abnormalities in high risk fetuses.

Influence of fetal breathing and movements on variability of umbilical Doppler indices using different numbers of waveforms.

Umbilical artery continuous-wave Doppler ultrasound waveforms were obtained from three groups of fetuses in late gestation: during quiescence, fetal breathing movements, and fetal body movements. The coefficients of variation, calculated from three values for each Doppler index, which were derived from one, two, four, six and eight waveforms, decreased as the number of waveforms increased. However, statistical analysis showed no significant improvement in variance when more than four waveforms were used during fetal quiescence and breathing and when more than six waveforms were used during fetal movement. A minimum of six waveforms ensured coefficients of variation less than or equal to 10% even during fetal breathing and fetal movements.

Relationship between the Duration of Fetal Breathing Movements and Gestational Age and the Development ofthe Central Nervous System at 25&amp;ndash;32 Weeks of Gestation in Normal Pregnancy

In 15 pregnant women with normal pregnancy at 25-32 weeks of gestation, fetal breathing movements (FBM), fetal body movements and fetal heart rate were continuously and simultaneously recorded over a total period of 180 min. The frequency of successive FBM with a duration less than 10 s (apnea period greater than 3 s) showed a significant decrease (p less than 0.01), while the frequency of successive FBM with a duration greater than or equal to 30 s showed a significant increase from 25 to 32 weeks of gestation (p less than 0.001). Strong positive correlations were also demonstrated between the frequency of FBM with a duration of greater than or equal to 30 s and the number of fetal heart rate accelerations per hour, acceleration/fetal body movement ratio, and the value of fetal heart rate long-term variability. These results suggest that the length of the duration of successive FBM represents a useful parameter for the analysis of fetal respiratory patterns, and that a prolongation of the duration of successive FBM of an individual fetus is related to the functional development of the central nervous system.

Duration, amplitude and shape of accelerations in relation to fetal body movements in behavioral state 2F

The relationship between fetal movements and fetal heart rate accelerations was analyzed in 34 healthy near term fetuses. Periods of coincidence 2F (C2F) with a mean duration of 34 +/- 6 minutes per fetus were selected, with a total of 463 accelerations. Nineteen percent of single body movements and 71% of compilations of movements were accompanied by an acceleration. The minimal duration of single movements associated with accelerations was 4-5 seconds. Movements with associated accelerations differed significantly in duration from movements without accelerations. The duration of accelerations was strongly correlated with the duration of movements. The amplitude of accelerations was not clearly correlated with the duration of movements, but depended on the type of movement. The shape of accelerations appeared to be dependent on the timing of the various fetal movements. In 77%, the number of notches in the accelerations was equal to the number of pauses in the movement complications. A discrepancy between notches in accelerations and pauses in movements could be explained in the majority of cases when the timing of the various movements in relation to one another was considered, or by the presence of fetal mouth movements.

Acute effects of maternal cigarette smoking on fetal heart rate and fetal body movements felt by the mother

Acute effects of maternal cigarette smoking on fetal heart rate (FHR) and fetal body movements felt by the mother (FM) were studied in 51 pregnant volunteers. Thirty four were chronic smokers (6 or more cigarettes per day, with an average of 14 cigarettes/day) and 17 were sporadic smokers (1 to 5 cigarettes per day, with an averaged of 3 cigarettes/day). In both groups the number of FM, fetal reactivity and short-term FHR variability decreased significantly in the 20 minutes following cigarette smoking; a sustained FHR rise of 10 or more beats/min was also found after the cigarette in more than 50% of the cases in the 2 groups. No statistically significant differences were found among the 2 groups when the post-cigarette data were compared. We conclude that maternal cigarette smoking produces important acute effects upon FM and FHR regardless the average daily number of cigarettes smoked by the mother.

The effect of maternal hyperoxia on behavioral activity in growth-retarded human fetuses

Thirteen pregnant women who subsequently were delivered of infants with birth weights less than the 3rd percentile were studied for examination of fetal heart rate and fetal activity patterns during maternal administration of oxygen at a concentration of 50% or room air for 2 hours. None of the fetuses was acidotic at birth. Maternal transcutaneous Po. levels increased from 79 ± 3 mm Hg to 158 ± 10 mm Hg for the 2 hours of observation. The results indicated that maternal hyperoxia produced sustained fetal breathing activity that was almost 100% higher than that in room air (analysis of variance, p = 0.024). Gross fetal body movements, fetal heart rate accelerations, and fetal heart rate variability increased significantly with increasing observation time (analysis of variance, p<0.01), but were not significantly altered by maternal hyperoxia or room air. We conclude that despite significant change in fetal breathing activity, ultrasonographic observation of fetal behavioral activity during maternal hyperoxia could not be used to differentiate severely growth-retarded from normally grown human fetuses. We speculate that altered fetal heart rate and fetal body movement patterns usually associated with intrauterine growth retardation might be related to altered development of the fetal central nervous system and are not reversible during prolonged maternal administration of oxygen.

Body and breathing movements in near-term fetuses and newborn infants of type-1 diabetic women

The generation of body and breathing movements was studied in relation to behavioural states in near-term fetuses ( n = 12) and newborn infants ( n = 7) of women with well-controlled type-1 diabetes. Results obtained from low-risk fetuses ( n = 12) and neonates ( n = 14) were used for comparison. Before birth, 2-h recordings were made of fetal heart rate and of fetal body movements, breathing and eye movements; the neonates were studied polygraphically during 6 h for heart rate, body movements, respiration, eye movements and EEG-pattern. The generation of body movements was similar in the fetuses of the diabetic and control groups. After birth, the duration per burst was longer in the diabetic group, both in state 1 and state 2, resulting in increased incidences. The incidence of fetal breathing movements tended to be higher in the diabetic group, but differences with the control group did not reach statistical significance. Breathing rate was considerably slower in fetuses of diabetic women present before birth. Periodic breathing occurred more often in the infants of diabetic women, especially in state 2 ( P < 0.02). Behavioural state organization was poor in the diabetic group, both before and after birth and resembled that of more immature fetuses and infants. The continuity of the poor behavioural state regulation from prenatal into postnatal life indicates that this cannot be attributed to the instantaneous unfavourable condition before birth. type-1 diabetes mellitus; fetus and newborn infant; behavioural states; body movements; breathing movements than in control fetuses, both in C1F ( P < 0.001) and C2F ( P < 0.002). This indicates altered regulation of breathing movements in diabetic pregnancy. In the neonates, breathing rate was identical in both groups. In either group breathing was slower in state 1 than in state 2; such a difference was not