Aim: To assess the coordination in the frequency of fetal facial expressions and reproducibility of fetal facial expression counting in normal singleton pregnancies in the third trimester of pregnancy using four-dimensional (4D) ultrasound.
Methods: One hundred and eleven healthy fetuses between 30 and 40 weeks of gestation were examined using 4D ultrasound. The frequencies of 7 facial expressions during 15-minute recordings were assessed. The fetuses were further divided into three gestational age groups (25 fetuses at 30-31 weeks, 43 at 32-35 weeks, and 43 at ≥36 weeks). Correlation analysis between each frequency and other fetal facial expressions in each gestational age group was performed to determine the change in the number of significant correlations with advancing gestation.
Results: Only two significant correlations were identified among 21 combinations of facial expressions at 30-31 and 32-35 weeks of gestation, whereas more frequent correlations (nine significant correlations) were noted at 36 to 40 weeks (p = 0.009). All fetal facial expressions showed intra- and inter-class correlation coefficients greater than 0.72, with good intra- and inter-observer agreements.
Conclusion: Our results suggest that the coordination of different parts of the fetal brain controlling facial expressions become apparent after 36 weeks of gestation because of the mature development of the fetal brain and central nervous system. To the best of our knowledge, this is the first study on the reproducibility assessment of fetal facial expression counting using 4D ultrasound.
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