Donald School Journal of Ultrasound in Obstetrics and Gynecology

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2023 | January-March | Volume 17 | Issue 1

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PICTURE OF THE MONTH

Toshiyuki Hata, Tomomi Kawahara, Miyu Konishi, Saori Bouno, Tomomi Yamanishi, Aya Koyanagi, Takahito Miyake

Three-vessel Trachea View of Fetal Vascular Ring: HDlive Flow with Spatiotemporal Image Correlation and HDlive Silhouette Study

[Year:2023] [Month:January-March] [Volume:17] [Number:1] [Pages:4] [Pages No:1 - 4]

Keywords: Color Doppler, Fetus, High-definition live, High-definition live flow, High-definition live silhouette, Right aortic arch, Spatiotemporal image correlation, Three-vessel trachea view, Vascular ring

   DOI: 10.5005/jp-journals-10009-1965  |  Open Access |  How to cite  | 

Abstract

Objective: In the present research study, we utilize high-definition live (HDlive) Flow with spatiotemporal image correlation (STIC), HDlive or high-definition live silhouette (HDlive Silhouette) to provide a three-vessel trachea perception of a fetal vascular loop. Case description: Four vascular loops were found throughout 37 months. Three were examined using color Doppler or HDlive Flow with STIC and HDlive or HDlive Silhouette. These techniques clearly showed the spatial relationships of the vascular ring and trachea in real-time. In addition, the abnormality in the left subclavian artery was also examined by HDlive Flow technique. Conclusion: Further, the identification of fetal great vessels and their adjacent structures were detected by HDlive Flow with STIC and HDlive or HDlive Silhouette, especially the three-vessel trachea image of a vascular loop.

306

ORIGINAL RESEARCH ARTICLE

Riko Takayoshi, Toshiyuki Hata, Yasunari Miyagi, Takahito Miyake, Kenji Kanenishi

Three-dimensional Power Doppler Ultrasonography Evaluation of Maternal Orbital Perfusion in Pregnancies with Gestational Diabetes Mellitus

[Year:2023] [Month:January-March] [Volume:17] [Number:1] [Pages:6] [Pages No:5 - 10]

Keywords: Gestational diabetes mellitus, Maternal orbital perfusion, Maternal orbital vascular sonobiopsy, Normal pregnancy, Three-dimensional power Doppler ultrasound

   DOI: 10.5005/jp-journals-10009-1966  |  Open Access |  How to cite  | 

Abstract

Objective: Determine the level of maternal orbital perfusion in gestational diabetes mellitus (GDM) pregnant women using maternal orbital vascular sonobiopsy (MOVS) and three-dimensional (3D) power Doppler ultrasound methods. Methods: The use of 3D power Doppler ultrasonography (3D-PDUS) for maternal orbital perfusion, together with virtual organ computer-aided analysis (VOCAL) histogram analysis, was carried out in 33 pregnancies between 25 and 40 weeks of gestation, including 18 cases of normal pregnancy (control) and 15 cases of gestational diabetes. The 3D power Doppler indices, such as the vascularization index (VI), flow index (FI), and vascularization FI (VFI), were calculated in both orbits of the individual group. The average value of each index for the two orbits was evaluated for further investigation. Both inter and intraobserver agreements of 3D-PDUS were examined. Results: In the Bland–Altman test, the mean percentage difference and 95% limits of intra and interobserver agreements for VI, FI, and VFI were 0.0803% (7.3417, -7.181) and -0.6823% (10.8095, -12.1742), -0.4816% (6.0624, -7.0256) and 0% (9.0746, -8.8384), and 0.0058% (2.6937, -2.6821) and -0.2892% (3.8910, -4.4694), respectively. The correlation for all three 3D-PD indices, that is, VI, FI, and VFI, was higher than 0.75 (0.7832–0.9749). The VI, FI, and VFI levels between control and GDM pregnancies did not change significantly. Conclusion: Our findings suggest that MOVS, which was assessed using 3D-PDUS and VOCAL histogram analysis, can offer fresh perspectives on observing maternal orbital perfusion in both healthy and dysfunctional pregnancies.

312

REVIEW ARTICLE

Aida Salihagic Kadic, Panos Antsaklis, Edin Medjedović, Sanja Tomasovic

From Structure to Function of Fetal Brain: A Long Journey

[Year:2023] [Month:January-March] [Volume:17] [Number:1] [Pages:25] [Pages No:11 - 35]

Keywords: Cerebral palsy, Kurjak's antenatal neurobehavioral test, Prenatal neurology, Structure and function of fetal brain

   DOI: 10.5005/jp-journals-10009-1962  |  Open Access |  How to cite  | 

Abstract

Understanding the structure and function of the fetal nervous system has been the dream of physicians for centuries. The pioneering efforts of Ian Donald in obstetric ultrasound (US) in the latter part of the 20th century have permitted this dream to become a reality. The initial contribution of obstetric US focused on normal and abnormal structures. Initially, anencephaly was described and followed by increasingly subtle central nervous system (CNS) abnormalities such as agenesis of the corpus callosum. The current and evolving challenge for investigators in obstetric US is to have similar success with the understanding of fetal neurological function. There are many functional neurological abnormalities, such as cerebral palsy (CP), whose causes are poorly understood. There are also an escalating number of results illustrating that a large presence of neurological problems, such as minimal cerebral dysfunction, schizophrenia, epilepsy, or autism, upshot at least in part from prenatal neurodevelopmental problems. Clinical and epidemiological studies have revealed that CP most often results from prenatal rather than perinatal or postnatal causes. Currently, although momentous advances in prenatal and perinatal care, there are no means to identify or expect the development of these disorders. Therefore, the development of diagnostic strategies to avoid and condense the saddle of perinatal brain damage has to turn into one of the most imperative tasks of contemporary perinatal medicine. The application of the new neurobehavioral test Kurjak's antenatal neurobehavioral test (KANET) might improve our understanding of prenatal neurodevelopmental events and possibly antenatal detection of CP and other neurological diseases.

356

REVIEW ARTICLE

Dubravka Hrabar

The Conscientious Objection of Physicians (Gynecologists) and the Value System

[Year:2023] [Month:January-March] [Volume:17] [Number:1] [Pages:11] [Pages No:36 - 46]

Keywords: Conscience, Conscientious objection, Law, Gynecologist

   DOI: 10.5005/jp-journals-10009-1956  |  Open Access |  How to cite  | 

Abstract

Conscience is a complex category of the human mind and characteristic only of a rational human being. Deliberations on conscience are frequently connected to the issue of a clash between one's own conscience and laws in force that makes provisions for a certain type of behavior. The question of conscience and conscientious objection appear not only as medical but also as an ethical and legal issue. Conscience is a category that knows no exceptions, although it may be displayed in various segments differently. A legal point of view knows two legal theories dealing with the relation between law and conscience—the natural law theory and the positivist law theory supported by legalism. This article shows how dangerous it was and still is to appreciate so called collective consciousness, excluding conscientious objection. Freedom of conscience is guaranteed by different international documents, and the right to appeal to one's own conscience is regulated by European documents. The European Court of Human Rights (ECHR) has passed different judgements on conscientious objections, including the issue of medical procedures, healthcare practitioners, pharmaceutics, life-sustaining treatment of patients etc. On European soil, there are yet different, although non-binding, resolutions (enacted by the European Parliament (EP) and Council of Europe) that some of them explicitly recognize the right to conscientious objection and some ”push” the right to abortion as a human right. When it comes to the problem of abortion and conscientious objection, according to the ECHR, the solution should be found in the so-called reasonable adjustment that could resolve the possible conflict of interest between the patient (embodied in his rights to autonomy, identity, own opinion, privacy or his wishes) and physicians (gynecologists) within the legal state obligation to provide medical service. The legal position of gynecologists means that they may claim conscientious objection without stating the reasons for any discrimination with respect to their labor rights. It should be taken into account that gynecologists are very much invited to claim conscientious objection if they feel it is their inner drive because they decide to help in creating life and maintaining pregnancy. The right to conscientious objection is the exercise of freedom of conscience, which is a human right emanating from democratic processes that should be the aim of modern society and legal order.

253

REVIEW ARTICLE

Morana Brkljacic

Medical Ethics in Gynecology and Perinatology

[Year:2023] [Month:January-March] [Volume:17] [Number:1] [Pages:7] [Pages No:47 - 53]

Keywords: Bioethics, Gynecology, Human being, Medical ethics, Medicine, Science

   DOI: 10.5005/jp-journals-10009-1958  |  Open Access |  How to cite  | 

Abstract

Background: This paper aims to present medical ethics in perinatal medicine as application of some key ethical principles to the practice of perinatal medicine. Methods: This is review of how medical science, combined with the progress of technology, has contributed in many ways to improving the maintenance of human health. Medical ethics acts as a functional interface between medicine, science, and ethics. Results: Medical ethics links scientific endeavor and its application into adaptive forms of ethical consensus. Its major elements are an increased understanding of biological systems and the responsible use of technology in tune with new scientific insights. When does a human being become a person? When does personhood end? These critical questions are some of the most interesting and affecting in medical ethics; at the beginning and end of life rights of the mother versus rights of the fetus, abortion, assisted reproduction and surrogacy are the hot-button issues that can be addressed with medical ethics. Conclusion: Bioethics should represent a new scientific ethics that connects humility, responsibility, and ability; a science that is interdisciplinary, cross-cultural and global, and that exalts the meaning of humanity. It perceives the man's well-being in the context of respect for nature, and as such, should become a kind of a “science of survival”.

389

REVIEW ARTICLE

Aris Antsaklis

The Fetus and Its Rights

[Year:2023] [Month:January-March] [Volume:17] [Number:1] [Pages:6] [Pages No:54 - 59]

Keywords: Ethics in perinatal medicine, Fetal rights, Fetal viability, Human life, The fetus as a patient

   DOI: 10.5005/jp-journals-10009-1955  |  Open Access |  How to cite  | 

Abstract

The moral, legal, and medical obligations to the fetus create a large number of serious legal and medical questions. The progressively increasing recognition of fetal rights in the field of law, such as tort, property, insurance, criminal procedure, and civil rights, raises questions that are related to the autonomy of the mother and the fetus. During the last 40 years, the technology of primitive embryonic stem cells has developed so much that in the near future, it seems very likely many incurable and devastating diseases that plague humanity will be controlled by employing therapies with such cells. An important, indeed, legal question is whether the ex utero ovum at the time of fertilization is considered a human being because, in this manner, it acquires the status of a natural person with all the legal rights that derive from it. According to theological and legal views, a human being deserves respect as a natural person from the very first moment of existence. Thus, a question appeared with particular acuteness—“when does human life begin?” A question that has occupied philosophers, theologians, and other intellectuals for many centuries. Today, the synthesis of scientific data, philosophical hypotheses, and problems of humanity has become a pressing necessity so that we can deal with the moral rights and social problems that come from the intervention of man in the various stages of life. The appropriate answer to the question, “when does human life begin?” and “how is human life defined?” is very perplexing. Today, dilemmas concerning the respect of human life from birth to death involve not only biology and medicine but also other sciences, such as philosophy, theology, psychology, sociology, legal, and political sciences, which have approached this issue from different points of view. There is a fine line between the responsibilities of science and those of metaphysics, and it seems that it depends on the philosophical principles of each of us. The concept of ethics in medical practice is older than this science itself, while for centuries, it remains the doctor's obligation to protect his patient's interests. More specifically, those interests which are related to patient's health are the avoidance of premature death, the cure or treatment of a disease, injury, or disability, and the avoidance of unnecessary physical and mental pain. All these are not just subjective findings but must be accompanied by a careful clinical evaluation by the attending physician for the sole purpose of defining which approach will be most beneficial to the patient, among those available. In the texts of Hippocrates, the meaning of “benefit or not to harm,” while in the Latin literature, the primum non nocere (first do no harm) dominates. The concept of the fetus as a patient has recently emerged as a major topic in perinatal medicine because when the fetus is treated as an independent patient, it is recommended to apply directed treatment, that is, a method of treatment that will benefit the fetus. When the fetus is not treated as a patient, a nondirected treatment could be acceptable and ethically satisfactory. The concept of the fetus as a patient essentially depends on various factors. One such factor is sustainability, which should be perceived with biological and technological parameters. When the embryo is viable, that is, when it has attained the maturity to be able to enter the neonatal period, with or without the assistance of technological support, or when it is presented to the doctor, then this fetus is considered a patient. The way one perceives fetal legal rights depends, to a large extent, on the degree of moral meaning which is attributed to the various stages of human development—fertilization, implantation, formation, development, functional and anatomical maturation, sensation, and sustainability. According to a specific legal point of view (by Jeremy Bentham) “rights do not depend on the ability to think but on the ability to feel.” But when does the fetus acquires the ability to think or feel? There is no clear answer here. The genetic machine is like an atomic bomb, with the need for special care. As the capabilities of this technology increase, more prudence and maturity are required for its use. However, history teaches that each major step in modern biotechnology initially causes moral vertigo, which fortunately resolves quickly. I close with the hope that most, if not all, understand the reflection arising from the acceptance of the notion that the embryo may have rights.

231

REVIEW ARTICLE

Amos Grünebaum, Joachim Dudenhausen, Frank A Chervenak

Ethical Lessons Learned from the COVID-19 Pandemic in Perinatal Medicine

[Year:2023] [Month:January-March] [Volume:17] [Number:1] [Pages:7] [Pages No:60 - 66]

Keywords: Coronavirus disease 2019 vaccine, Maternal morbidity, Maternal mortality, Neonatal morbidity, Neonatal mortality, Patient rights, Preterm birth, Therapeutic nihilism, Vaccine counseling, Vaccine recommendations

   DOI: 10.5005/jp-journals-10009-1957  |  Open Access |  How to cite  | 

Abstract

The COVID-19 pandemic is unprecedented in our lifetime, especially in perinatology. The gold standard is to strongly recommend COVID-19 vaccinations to those trying to get pregnant, to those who are pregnant, and to those who are postpartum. When the benefits of vaccines far outweigh the risks, it is unethical to disseminate wrong information and discourage patients from becoming vaccinated. COVID-19 vaccinations and boosters prevent severe diseases and adverse pregnancy and neonatal outcomes. A pregnant patient's vaccination also protects the newborn infant because maternal antibodies protect the fetus and newborn. COVID-19 vaccinations and boosters in pregnancy are safe for the pregnant patient and her fetus. The three root causes of physician hesitancy—misapplication of therapeutic nihilism, misapplication of shared decision-making, and misapplication of respect for autonomy should not be ignored and need to be addressed. It is important that we heed Brent 's insightful recommendations. Doing nothing with respect to vaccination is not an option, whether it applies to COVID-19 vaccines or to future pandemics. Physician hesitation is not an option. When there is sufficient evidence of vaccine safety and effectiveness without documented risks, vaccine recommendations before, during, and after pregnancy should be explicitly made to prevent maternal, fetal, and neonatal morbidity and mortality.

220

REVIEW ARTICLE

Amos Grunebaum, Frank A Chervenak

The Ethical Obligation to Prevent Maternal Mortality during the COVID-19 Pandemic and Beyond

[Year:2023] [Month:January-March] [Volume:17] [Number:1] [Pages:4] [Pages No:67 - 70]

Keywords: COVID-19, Hemorrhage, Maternal deaths, Mental health, Maternal mortality, Preeclampsia, Thromboembolism, United States

   DOI: 10.5005/jp-journals-10009-1961  |  Open Access |  How to cite  | 

Abstract

The United States of America (USA) has the highest maternal mortality rate of all high-income countries, with over 80% found to be preventable. After leveling off around 2015, maternal mortality rates in the USA further increased due to coronavirus disease 2019 (COVID-19) related deaths starting in 2020 by about 20% from about 17–18/100,000 live births to about 24/100,000 live births with about one in seven maternal deaths due to COVID-19 infections. The vast majority of COVID-19-related maternal deaths were among unvaccinated pregnant patients. A total of 11% of postpartum maternal deaths were found to be associated with mental health issues, with the remainder usually due to medical issues such as hemorrhage and hypertension. As physicians, we have the ethical obligation to address perinatal and maternal mortality, especially preventable maternal mortalities, reduce the discrepancy between different races and ethnicities, recommend COVID-19 vaccinations, and develop approaches to address the causes.

283

REVIEW ARTICLE

Ulla Marton, Asim Kurjak

Ethical Dimension of the Fetus with Malformation

[Year:2023] [Month:January-March] [Volume:17] [Number:1] [Pages:3] [Pages No:71 - 73]

Keywords: Chromosomal defects, Ethics, Fetal malformation, Management, Structural

   DOI: 10.5005/jp-journals-10009-1959  |  Open Access |  How to cite  | 

Abstract

The ethical dilemmas have an essential application in the clinical management of pregnancies complicated by fetal abnormalities with high respect for autonomy for both—mother and the fetus. Several options should be considered in the management of the pregnancy with a fetus which has either a structural or chromosomal defect.

214

REVIEW ARTICLE

Erden Radončić

The Ethical, Legal, and Social Issues Impacted by Assisted Reproductive Technologies in Croatia

[Year:2023] [Month:January-March] [Volume:17] [Number:1] [Pages:5] [Pages No:74 - 78]

Keywords: Assisted reproductive technology, Ethical issues, Legislation

   DOI: 10.5005/jp-journals-10009-1953  |  Open Access |  How to cite  | 

Abstract

Background: While assisted reproductive technology (ART), including in vitro fertilization (IVF), has given hope to millions of couples suffering from infertility, it has also introduced countless ethical, legal, and social challenges. The objective of this paper is to identify the influence of legislation and discuss various ethical, legal, and social aspects of ART in Croatia through various periods after its introduction in infertility treatment. Scope of review: This paper gives a short review and depicts the ethical, legal, and social challenges they introduce influenced by past and contemporary legislation in Croatia. Conclusion: In the future, advancing technology is likely to exacerbate the existing and open even more new ethical, legal, and social challenges. The ethical issues surrounding ART are complex and multifaceted, and they can be difficult to navigate. ART is directly challenging society to reevaluate the way in which human life, social justice, and equality are viewed. This is especially true for legislation whom which is expected to modify existing laws to accommodate the unique contemporary challenges created by ART.

487

REVIEW ARTICLE

Milan Stanojevic

Infants at the Limits of Viability: Medical and Ethical Aspects

[Year:2023] [Month:January-March] [Volume:17] [Number:1] [Pages:9] [Pages No:79 - 87]

Keywords: Artificial uterus, Limits of viability, Microgravity, Outcome, Prematurity, Treatment

   DOI: 10.5005/jp-journals-10009-1963  |  Open Access |  How to cite  | 

Abstract

There is a continuity of intrauterine to extrauterine life. With the existing level of knowledge and technical possibilities, extrauterine survival above 50% without major morbidity in some developed countries is possible at 22 gestational weeks (GW), while anecdotal survival has been described even at 21 GW + 4 days. The possibility of extending the survival of the smallest premature infants has been challenging for many decades. Good results of the survival of tiny and immature infants are improving in developed countries, but survival without major morbidity is still stagnant. From the historical point of view, limits of viability changed in the last 150 years for many medical, economic, ethical, and other reasons from 32 to 22 weeks of gestation, but always related to already born infants. Almost 70 years ago and recently, treating extreme prematurity remains a difficult medical issue due to many iatrogenic injuries which can hardly be avoided by using existing modes of therapy, including a modern way of thinking, sophisticated technology, and drugs. Recent technological advancements may enable the translation of experimental models of the artificial uterus (AU) and the artificial womb technology (AWT), termed ectogenesis which is the partial or complete maturation of a developing embryo or fetus outside the human body, to clinical practice, raising many technical, medical, and ethical dilemmas. The AWT is investigated on animal models only, but even in the research model, microgravity and gravity (G), age, thermoregulation, and oxygenation (GATO) hypotheses have not been mentioned or considered, although they might be important for the development of the fetus at early gestations. It might be advisable to change the way of thinking and find the reasons pro and contra of microgravity use in AWT research, which may improve care for fetuses born at the lower limits of viability.

341

REVIEW ARTICLE

Suada Tinjiæ, Enida Nevačinović, Sabina Tinjić

Comparison of Fetal Behavior in Single and Twin Pregnancies with the Use of KANET Test

[Year:2023] [Month:January-March] [Volume:17] [Number:1] [Pages:3] [Pages No:88 - 90]

Keywords: Fetal behavior, Four-dimensional ultrasound, General movements, Growth and development, Twin pregnancies

   DOI: 10.5005/jp-journals-10009-1964  |  Open Access |  How to cite  | 

Abstract

Aim: According to the results of the Kurjak antenatal neurodevelopmental test (KANET) in comparison of fetal behavior in single and twin pregnancies with the use of KANET test. Materials and methods: Between May 2015 and December 2019, 66 low-risk single pregnancies were assessed with KANET, along with eight twin pregnancies between 28 and 38 weeks of gestation. Results: Out of 66 patients with single pregnancies, 64.02 (97%) had a normal KANET score, and 1.8 (3%) of them had a borderline KANET score. Out of eight patients with twin pregnancies, 7.84 (98%) had a normal KANET score and 0.16 (2%) of them had a borderline KANET score. Conclusion: Our data suggest that twins show different types of motility than singletons at the same gestational age. The difference in the number of normal, borderline, and abnormal KANET scores between singletons and twins was not statistically significant, although the differences were found in certain parameters of the test between singletons and twins. It could be concluded that movements in twins become more complex and occur more frequently with increasing gestational age.

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REVIEW ARTICLE

Sertaç Esin, Nilay C Balci, Deniz A Ince, Emre Gunakan, Ozden Turan, İlknur E Dogan, Birgul Varan, Latife A Karakas, Meltem Aksu, Ilkay Erdogan, Niyazi K Tokel, Ayse Ecevit

Kurjak Antenatal Neurodevelopmental Test in Fetal Congenital Heart Defects: A Comparison of Antenatal and Postnatal Tests

[Year:2023] [Month:January-March] [Volume:17] [Number:1] [Pages:6] [Pages No:91 - 96]

Keywords: Amiel-tison neurological assessment at term, Congenital heart defects, Fetal neurologic development, General movements assessment, Kurjak antenatal neurodevelopmental test

   DOI: 10.5005/jp-journals-10009-1952  |  Open Access |  How to cite  | 

Abstract

Aim & Background: Kurjak's antenatal development test (KANET) have been developed and aimed to detect fetuses at high neurodevelopmental risk by four-dimensional (4D) ultrasound. Congenital anomalies are one of the most important causes of infant mortality, and CHD remain at the forefront. With abnormal development of the cardiac structures, decreased cerebral oxygen or substrate supply may place the developing fetus at risk for altered brain growth or brain injury. Methods: In this study, we aimed to perform KANET test on fetuses with CHD in the antenatal period and Amiel-Tison (AT) test and General movements (GMs) in the postnatal period and compare antenatal and postnatal scores. Results: We have completed 38 KANET, 28 AT and 26 GMs tests in our cohort. Of thirty-eight infants who had KANET, median score was 15 (4–16). One patient (3%) had abnormal, 6 patients (16%) had borderline and 31 patients (81%) had normal scores. Five patients (18%) had minor, 14 patients (50%) had borderline and 9 patients (32%) had normal AT scores. Ten patients (38%) had normal and 16 (62%) patients had PR GMs scores. Of thirty patients who had normal KANET test scores, 25 patients had AT and 8 (32%) had normal, 4 (16%) had minor and 13 (52%) had borderline scores and 23 patients had GMs and 9 (39%) had normal and 14 (61%) had PR scores. There was only one patient with an abnormal KANET test. This patient's karyotype was turned out to be Trisomy 18. Antenatal KANET and postnatal AT and GMs test results were compared and there was no significant correlation between test results. Conclusion: KANET has become a valuable functional test for identifying fetuses at high risk for various neurological impairments. Clinical Significance: In our study, KANET test results were impressive and informative. Two trisomy 18 cases who died in the first day of life had lowest KANET test scores in our cohort. Thirty three percent of cases who had borderline scores at KANET resulted in postnatal exitus. Despite these results, most cases with moderate AT and PR GMs results had good outcomes according to follow up.

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REVIEW ARTICLE

Milan Stanojevic, Asim Kurjak, Edin Međedović

Brain Assessment from Fetus to Neonate in Terms of Morphology and Function: Role of Neonatologist

[Year:2023] [Month:January-March] [Volume:17] [Number:1] [Pages:6] [Pages No:97 - 102]

Keywords: Brain, Four-dimensional, Fetal behavior, Function, Neonate, Structure, Ultrasound

   DOI: 10.5005/jp-journals-10009-1960  |  Open Access |  How to cite  | 

Abstract

Assessment of the structure and function of the brain was enabled by the development of ultrasound (US) technology, which may depict how complicated developmental processes of the brain structure in utero can result in complex behavior of embryo and fetus. Extrauterine life is the continuation of intrauterine life, and transposing our knowledge of brain structure and function from prenatal to postnatal life is an important approach to making the distinction between normal and abnormal brain development and the early diagnosis of various structural or functional brain abnormalities. The invention of four-dimensional US (4D US) enabled the introduction of the Kurjak Antenatal Neurodevelopmental Test (KANET), which opened up a new field of fetal neurology. The KANET is a standardized and comprehensive method to evaluate fetal neurological condition objectively and reproducibly by observation of fetal behavior and general movements (GMs). Based on the existing investigation, if the KANET score is normal, then there is a high probability that the development of the infant will be normal, with a very low probability that the child with developmental delay would have been missed, while the prediction is more complicated if the score is abnormal or borderline.

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REVIEW ARTICLE

Srećko Gajović, Anton Glasnović

The Narratives vs Biological Evidence in Understanding Early Human Embryo Development: The Example of Homunculus in the Sperm

[Year:2023] [Month:January-March] [Volume:17] [Number:1] [Pages:3] [Pages No:103 - 105]

Keywords: Embryo, Fertilization, Gastrulation, Narrative, Organogenesis

   DOI: 10.5005/jp-journals-10009-1954  |  Open Access |  How to cite  | 

Abstract

The societal controversies addressing the human embryo and its features classify the embryo as a bio-object, where biological facts blend with the societal contexts. Here we consider a narrative of homunculus in the sperm based on the iconic image from 1694 by one of the first microscopists, Nicolaas Hartsoeker, as an example of male-derived deterministic understanding of embryo development. The narrative was confronted with the biological evidence of variability of the sexual reproduction and adaptive nature of human embryo development. The relations between narratives and biological evidence can contribute to the understanding of the societal perception of biological phenomena.

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