Donald School Journal of Ultrasound in Obstetrics and Gynecology

Register      Login

VOLUME 1 , ISSUE 4 ( October-December, 2007 ) > List of Articles


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

Guillermo Azumendi, Ingrid Marton, Asim Kurjak, Mislav Herman

Keywords : Cerebral palsy,fetal behavior,4D/3D ultrasonography,neurological assessment

Citation Information : Azumendi G, Marton I, Kurjak A, Herman M. An Attempt to Discover Antenatal Etiological Factors for Cerebral Palsy: What does 3D and 4D Ultrasonography Add?. Donald School J Ultrasound Obstet Gynecol 2007; 1 (4):29-39.

DOI: 10.5005/jp-journals-10009-1117

License: CC BY-NC 4.0

Published Online: 01-12-2008

Copyright Statement:  Copyright © 2007; The Author(s).


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.

PDF Share
  1. Cerebral palsy epidemiology: where are we now and where are we going? Dev Med Child Neurol 1992;34:547-51.
  2. Executive Committee for the Definition of Cerebral Palsy. Proposed definition and classification of cerebral palsy. Dev Med Child Neurol 2005;47:571-6.
  3. Cerebral palsy—definition, classification, etiology and early diagnosis. Indian J Pediatr 2005;72:865-8.
  4. Cerebral palsy: a reconceptualization of the spectrum. J Pediatr 2004;145(2Suppl):S3-7.
  5. The incidence of cerebral palsy. Am J Obstet Gynecol 1992;167:417-23.
  6. B. Can we prevent cerebral palsy? N Engl J Med 2003;349:1765-9.
  7. Temporal and demographic trends in cerebral palsy—fact and fiction. Am J Obstet Gynecol 2003;188:628-33.
  8. Cerebral Palsy. N Engl J Med 1994;33:188-95.
  9. Cerebral palsy and clinical negligence litigation: a cohort study. BJOG 2003;110:6-11.
  10. Intrapartum risk factors for newborn encephalopathy: The Western Australian case-control study. BMJ 1998;317:1554-8.
  11. Cerebral palsy—medicolegal aspects. J R Soc Med 2001;94:624-7.
  12. A template for defining a causal relation between acute intrapartum events and cerebral palsy: International consensus statement. BMJ 1999;319:1054-9.
  13. Defining the pathogenesis and pathophysiology of neonatal encephalopathy and cerebral palsy. Obstet Gynecol 2003;102:628-36.
  14. Cerebral palsy and application of the international criteria for acute intrapartum hypoxia. Obstet Gynecol 2006;107:1357-65.
  15. Strategies for the early diagnosis of cerebral palsy. J Pediatr 2004;145:S8-S11.
  16. Factors identified during the neonatal period associated with risk of cerebral palsy. Aust New Zeland J Obstet Gynaecol 2004;44:342-6.
  17. Neonatal signs as predictors of cerebral palsy. Pediatrics 1979;64:225-32.
  18. The Amiel-Tison neurological assessment at term: conceptual and methodological continuity in the course of follow-up. Ment Retard Dev Disabil Res Rev 2005;11:34-51.
  19. Prechtl's method on the qualitative assessment of general movements in preterm, term and young infants. Mac Keith Press: Cambridge, 2004.
  20. General movements: a window for early identification of children at high risk for developmental disorders. J Pediatr 2004;145:S12-8.
  21. Neurobehavioral assessment before birth. Ment Retard Dev Disabil Res Rev 2005;11:4-13.
  22. Ontogenesis of goal-directed behavior: anatomo-functional considerations. International J Psychophysiology 1995;19:85-102.
  23. Early onset of synapse formation in the human hippocampus: a correlation with Nissl-Golgi architectonics in 15-and 16. 5-week-old fetuses. Neuroscience 1989;30:105-16.
  24. Prenatal influences on the brainstem development of preterm infants. In Jones CT, Mott JC, Nathanielsz PW (Eds): Physiological Developments of the Fetus and Newborns. Oxford: Academic Press, 1985;pp 627.
  25. Fetal motility in the first half of pregnancy. In Prechtl HFR (Ed): Continuity of neural functions from prenatal to postnatal life. Oxford, Blackwell. Clin Dev Med 1984;94:46-63.
  26. Comparison between observation of spontaneous movements and neurologic examination in preterm infants. J Pediatr 1997;130:704-11.
  27. Cerebral palsy and intrauterine growth in single births. European collaborative study. Lancet 2003;362:1106.
  28. Identification and differentiation of fetal movements. Contrib Gynecol Obstet 1979;6:29-32.
  29. Ultrasound movement patterns of fetuses with chromosomal anomalies. Prenat Diagn 1982;2:61-5.
  30. Posture, spontaneous movements, and behavioral state organisation in infants affected by brain malformations. Early Hum Dev 1997;50:87-113.
  31. Structural and functional early human development assessed by three-dimensional and four-dimensional sonography. Fertil Steril 2005;84:1285-99.
  32. The antenatal development of fetal behavioral patterns assessed by four-dimensional sonography. J Matern Fetal Neonat Med 2005;17:401-16.
  33. Morphological and dynamic assessment of fetal growth restriction by three-dimensional sonography. Doctor Thesis. Medical Scholl University of Zagreb, Zagreb, 2006.
  34. Behaviour of anencephalic fetus studied by 4D sonography. J Matern Fetal Neonat Med 2005;17:165-8.
  35. Prechtl's assessment of general movements. A diagnostic tool for the functional assessment of the young nervous system. MRDD Research Reviews 2005;11:61-7.
  36. Developmental outcome and follow-up of the small for gestational age infant. Semin Perinatol 1984;8:123-56.
  37. 4D, or not 4D: that is the question. Ultrasound Obstet Gyenecol 2002;19:1-4.
  38. Neonatal Behavioural Assessment Scale (2nd edn). JB Lippincott: Philadelphia, 1984.
  39. Cerebral palsy in preterm infants: a population based case-control study of antenatal and intrapartal risk factors. Acta Pediatr 2002;91:946-51.
  40. Prenatal diagnosis: what does four-dimensional ultrasound add? J Perinat Med 2002;30:57-62.
  41. Fetal hand and facial expression in normal pregnancy studied by four-dimensional sonography. J Perinat Med 2003;31:496-508.
  42. Three-dimensional and four-dimensional sonography in the study of the fetal face. Ultrasound Rev Obstet Gynecol 2003;3:160-9.
  43. Fetal behaviour assessed in all three trimesters of normal pregnancy by four-dimensional ultrasonography. Croat Med J 2005;46:772-80.
  44. The assessment of embryonic and fetal neurodevelopment in early pregnancy: comparison between 2D and 4D sonographic scanning. J Perinat Med 2005;33:406-14.
  45. Assessment of fetal behavior and general movements by four-dimensional sonography. Ultrasound Rev Obstet Gynecol 2004;4:103-14.
  46. 3D and 4D sonography in the evaluation of normal and abnormal fetal facial expression. In Carrera JM, Kurjak A (Eds): Atlas of Clinical Application of Ultrasound in Obstetrics and Gynecology. Jaypee Brothers Medical Publishers: New Delhi, 2006;pp250.
  47. Three dimensional sonoembriology. In Kurjak A, Arenas JB (Eds): Textbook of Transvaginal Sonography. Taylor & Francis: London, 2005;pp 407.
  48. Fetal ultrasonography: the first 40 years. Ultrasound Rev Obstet Gynecol 2004;4:141-7.
  49. Behavioral perinatology assessed by four dimensional sonography. In Kurjak A, Chervenak F (Eds): Textbook of Perinatal Medicine. Jaypee Brothers Medical Publishers: New Delhi, 2005;pp568.
  50. Behavioral pattern continuity from prenatal to postnatal life—a study by four-dimensional (4D) ultrasonography. J Perinat Med 2004:32:346-53.
  51. The potential of four-dimensional (4D) ultrasonography in the assessment of fetal awareness. J Perinat Med 2005;33:46-53.
  52. Ultrasound studies of human fetal behaviour. Early Hum Dev 1985;12:91-8.
  53. Normal standards for fetal neurobehavioral developments—longitudinal quantification by four-dimensional sonography. J Perinat Med 2006;34:56-65.
  54. The emergence of fetal behavior. II Quantitative aspects. Early Hum Dev 1985;12:99-120.
  55. Predictive value of assessment of general movements for neurological development of high-risk preterm infants: comparative study. Croat Med J 2003;44:721-7.
  56. The qualitative assessment of general movements in preterm, term and young infants—review of the methodology. Early Hum Dev 1997;24:47-60.
  57. Classification and quantitative aspects of fetal movements during the second half of pregnancy. Early Hum Dev 1991;25:19-35.
  58. Which better predicts later outcome in full term infants: quality of general movements or neurological examination? Early Hum Dev 1997;50:71-85.
  59. Cramped synchronized general movements in preterm infants as an early marker for cerebral palsy. Arch Pediatr Adolesc Med 2002;156:460-7.
  60. State of the art of a new functional assessment of the young nervous system. An early predictor of cerebral palsy. Early Hum Dev 1997;50:1-11.
  61. An atlas of Three-and Fourdimensional Sonography in Obstetrics and Gynecology. Taylor & Francis Group: London, 2004.
  62. Anatomic and physiologic correlates of neurologic development in prematurity. In Sarnat HB (Ed): Topics in Neonatal Neurology. New York: Grune and Stratton 1984;pp 1-24.
  63. Functions of the corticospinal and corticobulbar tracts in the human newborns. J Pediatr Neurol 2003;1:3-8.
  64. Clinical assessment of the infant nervous system. In Levente MI, Chervenak FA, Whittle M (Eds): Fetal and Neonatal Neurology and Neurosurgery (3rd edn). Churchill Livingstone: London, 2001;pp 99-120.
  65. Update of the Amiel-Tison neurologic assessment for the term neonate or at 40 weeks corrected age. Pediatr Neurol 2002;27:196-212.
  66. Neurobehavioral assessment from fetus to infant: the NICU network neurobehavioral scale and the fetal neurobehavioral coding system. MRDD Research Reviews 2005;11:14-20.
  67. Clinical application of three-dimensional ultrasound in fetal brain assessment. Croat Med J 2000;41:245-51.
  68. Three-dimensional ultrasound assessment of the fetal and neonatal brain. Ultrasound Rev Obstet Gynecol 2003;3:117-30.
  69. Ultrasound antenatal diagnosis of cleft palate by a new technique: the 3D “reverse face” view. Ultrasound Obstet Gynecol 2005;25:12-8.
  70. Normal and abnormal fetal hand positioning and movement in early pregnancy detected by three-and fourdimensional ultrasound. Ultrasound Rev Obstet Gynecol 2004;4:46-51.
  71. An attempt to produce neurological test for fetus based on 4D sonogrphy. J Matern Fetal Neonat Med 2007 (submitted for publication).
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.