An Attempt to Discover Antenatal Etiological Factors for Cerebral Palsy: What does 3D and 4D Ultrasonography Add?

JOURNAL TITLE: Donald School Journal of Ultrasound in Obstetrics and Gynecology

Author
1. Guillermo Azumendi
2. Ingrid Marton
3. Asim Kurjak
4. Mislav Herman
ISSN
0973-614X
DOI
10.5005/jp-journals-10009-1117
Volume
1
Issue
4
Publishing Year
2007
Pages
11
Author Affiliations
    1. Clinica Gutenberg, Malaga, Spain
    2. Centro Gutenberg, Malaga, C/ Gutenberg n°1 Malaga
    1. Medical School University of Zagreb Sveti Duh Hospital Zagreb, Croatia
    2. Clinical Hospital Sveti Duh, Cratian Catholic University, Zagreb, Croatia
    1. Department of Obstetrics and Gynecology, Medical School, University of Zagreb, Sveti Duh Hospital, Zagreb, Croatia
    1. Department of Obstetrics and Gynecology, Medical School, University of Zagreb, Petrova Hospital, Zagreb, Croatia
  • Article keywords
    Cerebral palsy, fetal behavior, 4D/3D ultrasonography, neurological assessment

    Abstract

    Cerebral palsy (CP) is a nonprogressive condition affecting developing fetal or infant brain resulting in disorders of movement and posture which are sometimes accompanied by disturbances of cognition, sensation, perception, behavior and seizures. The incidence of CP being 2 to 2.5 per 1000 live births did not considerably change in the last decades. Improvement of perinatal care did not result in the decreasing prevalence of CP. Consensus Statement of International Cerebral Palsy Task Force and its modification presented the essential criteria to define an acute intrapartum event sufficient to cause CP. These criteria were not helpful in allocating the time of brain injury, proving that etiology of CP is difficult to investigate. Better markers of acute intrapartum injury should be defined, although much evidence exists that most causes of CP are prenatal. Advances in 3D and 4D ultrasound (US) give opportunities to investigate fetal morphology and behavior. By 4D US, head, body and limb movements can be visualized simultaneously. The earliest phase of development can be studied in detail, making 4D superior compared to 2D. Is applicable neurological test for fetus available? This question is complicated, because even postnatally several neurological methods of evaluation exist, while hardly accessible fetus has less mature brain. Inexistence of reliable neurobehavioral assessment method for the fetuses is discouraging. The scientific community should intensify efforts in finding out simple, clinically applicable, and reproducible fetal neurological test(s), with fair sensitivity and specificity.

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