Citation Information :
Medjedović E, Kurjak A, Jonuzovic-Prosic S, Suljevic A. Recent Advances in the Assessment of Fetal Behavior in Preeclamptic Patients. Donald School J Ultrasound Obstet Gynecol 2022; 16 (1):11-18.
Preeclampsia has a significant effect on maternal and fetal health, and in the most severe cases may lead to significant early or late-onset intrauterine growth restriction (IUGR), which can be diagnosed by ultrasound. In moderately severe and mild preeclampsia, the consequences for the fetus may be less severe. The main effect of preeclampsia on the fetus is malnutrition as the result of hypoxia due to uteroplacental vascular insufficiency, which occurs in approximately 30% of fetuses from preeclamptic pregnancies. This leads to various perinatal and neonatal complications including IUGR, emergency cesarean section (CS), premature birth, low birth weight, low APGAR scores, and often a longer stay in the neonatal intensive care unit and more severe acute respiratory distress syndrome after birth. The question is whether these consequences can be detected, and are there any indicators of early fetal distress before the development of growth restriction? Therefore, the aim is to investigate if observation of fetal behavior using four-dimensional ultrasound (4D US) in pregnancies with preeclampsia can reveal signs which could be added to existing diagnostic criteria for preeclampsia. The four-dimensional US offers the possibility of simultaneous visualization of real-time movements of the head, body, and all four extremities in three dimensions. Using the 4D US for assessment of fetal behavior and postnatal neuropediatric knowledge, a group from Zagreb proposed a prenatal screening test for assessment of the motor activity of the fetus, known as the Kurjak Antenatal Neurodevelopmental Test (KANET). The aim of the paper is to show that KANET is one of the most relevant tools for the assessment of fetal behavior, particularly in patients who are affected by preeclampsia. Based on our investigation we showed that preeclampsia clearly affects fetal behavior. The KANET test has proven to be a safe tool in assessing fetal neurodevelopment, especially in those at risk affected by severe preeclampsia. Prenatal fetal assessment is of great help to neonatologists in preparing for adequate and timely resuscitation procedures at birth. Low KANET scores always prompted close and intensive follow-up in pregnancies with severe preeclampsia to avoid adverse outcomes in both pregnant women and fetuses.
Lorenzo GD, Ceccarello M, Cecotti V, et al. First trimester maternal serum PIGF, free β-hCG, PAPP-A, PP-13, uterine artery dopler and maternal history for the prediction of preeclampsia. Placenta 2012;33(6):495–501. DOI: 10.1016/j.placenta.2012.03.003
Impey L, Greenwood C, Sheil O, et al. The relation between pre-eclampsia at term and neonatal encephalopathy. Arch Dis Child Fetal Neonatal Ed 2001;85(3):F170–F172. DOI: 10.1136/fn.85.3.f170
Osungbade KO, Ige OK. Public health perspectives of preeclampsia in developing countries: implication for health system strengthening. J Pregnancy 2011;2011:481095. DOI: 10.1155/2011/481095
Berhe AK, Kassa GM, Fekadu GA, et al. Prevalence of hypertensive disorders of pregnancy in Ethiopia: a systemic review and meta-analysis. BMC Pregnancy Childbirth 2018;18(1):34. DOI: 10.1186/s12884-018-1667-7
Okby R, Harlev A, Sacks KN, et al. Preeclampsia acts differently in in vitro fertilization versus spontaneous twins. Arch Gynecol Obstet 2018;297(3):653–658. DOI: 10.1007/s00404-017-4635-y
Healy AJ, Malone FD, Sullivan LM, et al. Early access to prenatal care: implications for racial disparity in perinatal mortality. Obstet Gynecol 2006;107(3):625–631. DOI: 10.1097/01.AOG.0000201978.83607.96
Hutcheon JA, Lisonkova S, Joseph KS. Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy. Best Pract Res Clin Obstet Gynaecol 2011;25(4):391–403. DOI: 10.1016/j.bpobgyn.2011.01.006
MacKay AP, Berg CJ, Atrash HK. Pregnancy-related mortality from preeclampsia and eclampsia. Obstet Gynecol 2001;97(4):533–538. DOI: 10.1016/s0029-7844(00)01223-0
Waterstone M, Bewley S, Wolfe C. Incidence and predictors of severe obstetric morbidity: case-control study. BMJ 2001;322(7294):1089–1093. DOI: 10.1136/bmj.322.7294.1089
Ghulmiyyah L, Sibai B. Maternal mortality from preeclampsia/eclampsia. Semin Perinatol 2012;36(1):56–59. DOI: 10.1053/j.semperi.2011.09.011
Callaghan WM, Creanga AA, Kuklina EV. Severe maternal morbidity among delivery and postpartum hospitalizations in the United States. Obstet Gynecol 2012;120(5):1029–1036. DOI: 10.1097/aog.0b013e31826d60c5
DeCarlo C, Boitano LT, Molina RL, et al. Pregnancy and preeclampsia are associated with acute adverse peripheral arterial events. Arterioscler Thromb Vasc Biol 2021;41(1): 526–533. DOI: 10.1161/ATVBAHA.120.315174
Backes CH, Markham K, Moorehead P, et al. Maternal preeclampsia and neonatal outcomes. J Pregnancy 2011;2011:214365. DOI: 10.1155/2011/214365
Sánchez-Aranguren LC, Prada CE, Riaño-Medina CE, et al. Endothelial dysfunction and preeclampsia: role of oxidative stress. Front Physiol 2014;5:372. DOI: 10.3389/fphys.2014.00372
Staff AC. The two-stage placental model of preeclampsia: an update. J Reprod Immunol 2019;134-135:1–10. DOI: 10.1016/j.jri.2019.07.004
Lain KY, Roberts JM. Contemporary concepts of the pathogenesis and management of preeclampsia. JAMA 2002;287(24):3183–3186. DOI: 10.1001/jama.287.24.3183
Itoh H, Knayama N. Obesity and risk of preeclampsia. Med J Obstet Gynecol 2014;2(2):1024.
Trogstad L, Magnus P, Stoltenberg C. Pre-eclampsia: risk factors and causal models. Best Pract Res Clin Obstet Gynaecol 2011;25(3):329–342. DOI: 10.1016/j.bpobgyn.2011.01.007
Rana S, Lemoine E, Granger JP, et al. Preeclampsia: pathophysiology, challenges, and perspectives. Circ Res 2019;124(7):1094–1112. DOI: 10.1161/CIRCRESAHA.118.313276
Prechtl HF. Developmental neurology of the fetus. Baillieres Clin Obstet Gynaecol 1988;2(1):21–36. DOI: 10.1016/s0950-3552(88)80061-0
Einspieler C, Prechtl HFR, Bos AF, et al. Prechtl's method on the qualitative assessment of general movements in preterm, term and young infants. Mac Keith Press, Cambridge, 2004.
Hadders-Algra M. General movements: a window for early identification of children at high risk for developmental disorders. J Pediatr 2004;145(2 Suppl):S12–S18. DOI: 10.1016/j.jpeds.2004.05.017
Hadders-Algra M, Philippi H. Predictive validity of the general movements assessment: type of population versus type of assessment. Dev Med Child Neurol 2018;60(11):1186. DOI: 10.1111/dmcn.14000
DiPietro JA, Costigan KA, Voegtline KM. Studies in fetal behavior: revisited, renewed, and reimagined. Monogr Soc Res Child Dev 2015;80(3):vii-vii94. DOI: 10.1111/mono.v80.3
Kurjak A, Miskovic B, Stanojevic M, et al. New scoring system for fetal neurobehavior assessed by three- and four-dimensional sonography. J Perinat Med 2008;36:73–81. DOI: 10.1515/JPM.2008.007
Nelson CA: Neural development and lifelong plasticity. In: Keating DP (ed.): Nature and Nurture in Early Child Dev Cambridge University Presselopment. Cambridge: UK, 2011: 45–69.
Prechtl HF. The history of fetal movement studies. Neurophysiology and Neuropsychology of Motor Development. 1997:42.
Salihagic Kadic A, Predojevic M, Kurjak A. Advances in fetal neurophysiology. Fetal neurology. New Delhi: Jaypee Brothers Medical Publishers. 2009:161–219.
Kurjak A, Azumendi G, Vecek N, et al. Fetal hand movements and facial expression in normal pregnancy studied by four-dimensional sonography. J Perinat Med 2003;31(6):496–508. DOI: 10.1515/JPM.2003.076
Pooh RK, Ogura T. Normal and abnormal fetal hand positioning and movement in early pregnancy detected by three- and four-dimensional ultrasound. Ultrasound in Obstetrics and Gynecology 2004;4(1):46–51. DOI: 10.3109/14722240410001700249
Serón-Ferré M, Ducsay CA, Valenzuela GJ. Circadian rhythms during pregnancy. Endocr Rev 1993;14(5):594–609. DOI: 10.1210/edrv-14-5-594
Kurjak A, Andonotopo W, Hafner T, et al. Normal standards for fetal neurobehavioral developments–longitudinal quantification by four–dimensional sonography. J Perinat Med 2006;34(1):56–65. DOI: 10.1515/JPM.2006.007
Reissland N, Kisilevsky BS, editors. Fetal development: research on brain and behavior, environmental influences, and emerging technologies. Springer; 2016.
Joseph R. Fetal brain behavior and cognitive development. Dev Rev 2000;20(1):81–98. DOI: 10.1006/drev.1999.0486
Kadic AS, Predojevic M. Fetal neurophysiology according to gestational age. Semin Fetal Neonatal Med 2012;(5):256–260. DOI: 10.1016/j.siny.2012.05.007
Stanojevic M, Kurjak A, Salihagić-Kadić A, et al. Neurobehavioral continuity from fetus to neonate. J Perinat Med 2011;39(2): 171–177. DOI: 10.1515/jpm.2011.004
Kurjak A, Stanojevic M, Salihagic-Kadic A, et al. Is four-dimensional (4D) ultrasound entering a new field of fetal psychiatry? Psychiatr Danub 2019;31(2):133–140. DOI: 10.24869/psyd.2019.133
Kurjak A, Stanojevic M, Predojevic M, et al. Neurobehavior in fetal life. Semin Fetal Neonatal Med 2012;17(6):319–323. DOI: 10.1016/j.siny.2012.06.005
Kadic AS, Kurjak A. Cognitive functions of the fetus. Ultraschall Med 2018;39(2):181–189. DOI: 10.1055/s-0043-123469
Salihagic-Kadic A, Kurjak A, Medic M, et al. New data about embryonic and fetal neurodevelopment and behavior obtained by 3D and 4D sonography. J Perinat Med 2005; 33(6):478–490. doi: 10.1515/JPM.2005.086.
Junge HD. Behavioral states and state related heart rate and motor activity patterns in the newborn infant and the fetus antepartum—A comparative study. I. Technique, illustration of recordings, and general results. J Perinat Med 1979;7(2): 85–103. DOI: 10.1515/jpme.1918.104.22.168
den Bergh BRHV, Mulder EJH. Fetal sleep organization: a biological precursor of self-regulation in childhood and adolescence? Biol Psychol 2012;89(3):584–590. DOI: 10.1016/j.biopsycho.2012.01.003
Nomura Y, John RM, Janssen AB, et al. Neurodevelopmental consequences in offspring of mothers with preeclampsia during pregnancy: underlying biological mechanism via imprinting genes. Arch Gynecol Obstet 2017;295(6):1319–1329. DOI: 10.1007/s00404-017-4347-3.
Warshafsky C, Pudwell J, Walker M, et al. Prospective assessment of neurodevelopment in children following a pregnancy complicated by severe pre-eclampsia. BMJ Open 2016;6(7):e010884. DOI: 10.1136/bmjopen-2015-010884
Vuković - Bobić M, Habek D. Biljezi rane detekcije preeklampsije. Gynaecol Perinatol 2013; 22(1):1–8.
Lopez-Mendez MA, Martinez-Gaytan V, Cortes-Flores R, et al. Doppler ultrasound evaluation in preeclampsia. BMC Res Notes 2013;6:477. DOI: 10.1186/1756-0500-6-477
Paauw ND, Lely AT. Cardiovascular sequels during and after preeclampsia. Adv Exp Med Biol 2018;1065:455–470. DOI: 10.1007/978-3-319-77932-4_28
Al-Amin A, Rolnik DL, Black C, et al. Accuracy of second trimester prediction of preterm preeclampsia by three different screening algorithms. Aust N Z J Obstet Gynaecol 2018;58(2):192–196. DOI: 10.1111/ajo.12689
Kurjak A, Antsaklis P, Stanojevic M, et al. Multicentric studies of the fetal neurobehavior by kanet test. J Perinat Med 2017;45(6):717–727. DOI: 10.1515/jpm-2016-0409
Kurjak A, Spalldi Barisic L, Stanojevic M, et al. Multi-center results on the clinical use of kanet. J Perinat Med 2019;47(9):897–909. DOI: 10.1515/jpm-2019-0281
Talic A, Kurjak A, Ahmed B, et al. The potential of 4D sonography in the assessment of fetal behavior in high-risk pregnancies. J Matern Fetal Neonatal Med 2011;24:948–954. DOI: 10.3109/14767058.2010.534830
Tinjic S. Experiences and results of the kanet test application in clinical practice in bosnia and herzegovina: Tuzla. Donald Sch J Ultrasound Obstet Gynecol 2019;13:94–98. DOI: 10.5005/jp–journals-10009-1595.
Honemeyer U, Talic A, Therwat A, et al. The clinical value of KANET in studying fetal neurobehavior in normal and at-risk pregnancies. J Perinat Med 2013;41(2):187–197. DOI: 10.1515/jpm-2011-0251
Kerley RN, McCarthy C. Biomarkers of glomerular dysfunction in pre–eclampsia –a systematic review. Pregnancy Hypertens 2018;14:265–272. DOI: 10.1016/j.preghy.2018.03.002
Duhig K, Vandermolen B, Shennan A. Recent advances in the diagnosis and management of pre-eclampsia. F1000Res 2018;7:242. DOI: 10.12688/f1000research.12249.1
Medjedovic E. The influence of blood flow in uterine arteries measured by Doppler on fetal behavior in preeclampsia. PhD thesis. Sarajevo School of Science and Technology, Sarajevo, 2021.
Karateke A, Kurt RK, Baloğlu A. Relation of platelet distribution width (PDW) and platelet crit (PCT) to preeclampsia. Ginekol Pol 2015;86(5):372–375. DOI: 10.17772/gp/2425
Dai DM, Cao J, Yang HM, et al. Hematocrit and plasma albumin levels difference may be a potential biomarker to discriminate preeclampsia and eclampsia in patients with hypertensive disorders of pregnancy. Clin Chim Acta 2017;464:218–222. DOI: 10.1016/j.cca.2016.12.001
Cetin BA, Mathyk BA, Cift T, et al. Serum collectrin levels in patients with early- and late-onset preeclampsia. J Matern Fetal Neonatal Med 2017;31(23):1–5. DOI: 10.1080/14767058.2017.1357692
Corominas AI, Balconi SM, Palermo M, et al. Serum uric acid levels and risk of developing preeclampsia. Medicina (B Aires) 2014;74(6):462–471.
Gao YF, Huang QT, Zhong M, et al. Diagnostic value of radom spot albuminuria to creatinine ratio in women with preeclampsia. Zhonghua Fu Chan Ke Za Zhi 2012;47(3): 166–170.
Heilmann L, Siekmann U. Hemodynamic and hemorheological profiles in women with proteinuric hypertension of pregnancy and in pregnant controls. Arch Gynecol Obstet 246(3):159–168. DOI: 10.1007/BF00934077
Dacaj R, Izetbegovic S, Stojkanovic G, et al. Elevated liver enzymes in cases of preeclampsia and intrauterine growth restriction. Med Arch 2016;70(1):44–47. DOI: 10.5455/medarh.2016.70.44-47
Tanacan A, Fadiloglu E, Beksac MS. The importance of proteinuria in preeclampsia and its predictive role in maternal and neonatal outcomes. Hypertens Pregnancy 2019;38(2): 111–118. DOI: 10.1080/10641955.2019.1590718
Medjedovic E, Kurjak A. Doppler ultrasonography of the uterine artery in correlation with kanet. J Perinat Med 2021;49(4):455–459. DOI: 10.1515/jpm-2020-0544
Luetic AT. First experience in clinical application of kanet. Donald Sch J Ultrasound Obstet Gynecol 2015;9(1):96–99. DOI: 10.5005/jp-journals-10009-1395
Neto RM. KANET in Brazil: first experience. Donald Sch J Ultrasound Obstet Gynecol 2015;9(1):1–5. DOI: 10.5005/jp–journals–10009–1384
Vladareanu R, Lebit D, Constantinescu S. Ultrasound assessment of fetal neurobehaviour in high-risk pregnancies. Donald School J Ultrasound Obstet Gynecol 2012;6:1. DOI: 10.5005/jp-journals-10009-1235
Kurjak A, Talic A, Honemeyer U, et al. Comparison between antenatal neurodevelopmental test and fetal doppler in the assessment of fetal well being. J Perinat Med. 2013;41(1): 107–114. DOI: 10.1515/jpm-2012-0018
Athanasiadis AP, Mikos T, Tambakoudis GP, et al. Neurodevelopmental fetal assessment using kanet scoring system in low and high risk pregnancies. J Matern Fetal Neonatal Med 2013; 26(4):363–368. DOI: 10.3109/14767058.2012.695824
Hanaoka U, Hata T, Kananishi K, et al. Does ethnicity have an effect on fetal behavior? a comparison of Asian and Caucasian populations. J Perinat Med 2016;44(2):217–221. DOI: 10.1515/jpm-2015-0036
Okoye HC, Nwogoh B, Odetunde OI. Correlation of hematocrit and apgar scores in newborns of women with hypertensive disorders in pregnancy. J Neonatal Perinatal Med 2017;10(4):387–392. DOI: 10.3233/NPM-16151