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VOLUME 13 , ISSUE 1 ( January-March, 2019 ) > List of Articles

REVIEW ARTICLE

4D in Functional Studies of the Fetus

Keywords : Fetal behavior, Four-dimensional ultrasonography, KANET test, Neurodevelopmental impairment

Citation Information : 4D in Functional Studies of the Fetus. Donald School J Ultrasound Obstet Gynecol 2019; 13 (1):23-33.

DOI: 10.5005/jp-journals-10009-1582

License: CC BY-NC 4.0

Published Online: 01-04-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Abstract

Assessing fetal neurobehavior has been a great challenge since the first steps of fetal medicine. The introduction of three-dimensional (3D) and four-dimensional (4D) ultrasound technology offered the opportunity to not only examine the fetus anatomically with explicit detail but also to observe the fetus directly and examine its behavior in real time, as one would examine a neonate. The development of the fetal central nervous system (CNS) follows a very structured path and these developmental steps are reflected by the behavior of the fetus in utero for each corresponding week or trimester. Which fetal movements develop during each month and which fetal behavioral patterns are normal or abnormal have been identified. In the same way that a neonatologist can understand by its motoric function if a neonate is premature or not. Similarly, we can now understand which fetal movements-behavioral pattern corresponds to each trimester of pregnancy. Structural and functional impairment of the brain can develop at any time during pregnancy. The structural anomaly of the brain is much easier to detect than functional. Delayed diagnosis of a neurological problem will make the possibility of timely treatment is rather doubtful. It is clear that the assessment of fetal neurological status is of utmost importance, and should be practiced both as a screening test for low- and high-risk pregnancies. The most complete method so far for the assessment of fetal neurobehavior, that relays on real time observation of the fetal behavior with 4D ultrasound and its efficacy has been tested through many multicentric studies is Kurjak's antenatal neurodevelopmental test (KANET). KANET has been introduced in everyday clinical practice and aims to assess the fetal behavior in a similar way that a neonate is assessed postnatally, through 4D ultrasound technology. The KANET has been introduced into systematic training and already ultrasound specialists have been certified to perform this test. Hopefully, application of KANET on larger populations, both high and low risk, will give more knowledge regarding early detection of fetuses at risk for neurological impairment, to allow accurate diagnosis prenatally, and as a consequence prompt intervention that could improve the outcome of some of these neonates postnatally.

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