Women's response to fetal choroid plexus cysts detected by prenatal ultrasound.

OBJECTIVES: To determine maternal responses to detection of a minor structural variant, the choroid plexus cyst (CPC), in their fetus on prenatal ultrasound. STUDY DESIGN: We interviewed 34 pregnant women with an isolated CPC detected on mid-pregnancy ultrasound about their objective experience at diagnosis, emotional response and subsequent reactions. Audiotaped, transcribed responses were evaluated by two independent raters and analyzed qualitatively and quantitatively. RESULTS: All women reported negative emotional responses including shock, distress, fear and decreased attachment, despite counseling by 82% of providers that the CPC was probably benign. Three women underwent amniocentesis purely for reassurance after CPC detection. Most (79%) sought information beyond what their physician provided, frequently on the internet. One half of women reported that intense negative responses were temporary. However, weeks after diagnosis, 62% continued to believe that the CPC presented some danger to their baby. CONCLUSIONS: Detection of CPC prenatally can evoke profound, negative maternal emotional responses despite accurate provider counseling. Practitioners should consider these responses when counseling parents about these and other structural variants of unclear functional significance.

Choroid plexus cysts do not affect fetal neurodevelopment.

OBJECTIVE: To determine whether an isolated finding of a choroid plexus cyst (CPC) during routine ultrasound is associated with altered fetal growth or development. STUDY DESIGN: Prospective, case-control study comparing 35 CPC cases to 67 controls. Neurobehavioral development assessment included 50 min long serial recordings of heart rate, motor activity and their interrelation at 24, 28, 32 and 36 weeks gestation. Growth measurement was based on three ultrasound evaluations of femur length, biparietal diameter, head circumference and abdominal circumference at initial exam, 28 and 36 weeks. RESULTS: Longitudinal analyses revealed no differences in fetal heart rate, variability or accelerations; the number or duration of fetal movements or total motor activity; nor fetal movement-fetal heart rate coupling. CPC cases had slightly smaller head and abdominal circumferences at 28 weeks, but these differences had disappeared by 36 weeks. CPC detection was more common when routine exams were conducted earlier (18.8 versus 19.5 weeks; P<0.01). CONCLUSION: Despite the presumption that CPCs with normal karyotypes are benign variants, little empirical support exists. These results indicate that CPCs detected by prenatal ultrasound do not pose or reveal a threat to fetal development.

Development of fetal movement--fetal heart rate coupling from 20 weeks through term.

This study documents the development of fetal heart rate (FHR) change in response to fetal movement (FM) in healthy fetuses from 20 weeks' gestational age through term. Thirty-one fetuses received 50 min of Doppler-based monitoring at 20, 24, 28, 32, 36 and 38-39 weeks. FHR and FM were continuously digitized. A coupling index was computed as the percentage of FMs associated with increases in FHR of 5 beats/min or more within -5 or +15 s of movement onset. The latency between FM onset and FHR change was also computed, as were the amplitude and duration of all movements. FM and FHR became more integrated with advancing gestation. Coupling increased and the latency between FM and FHR changes decreased. Maternal age, blood pressure and fetal sex did not affect FM-FHR coupling, but fetuses of women who reported greater stress in their daily lives and had faster heart rates displayed reduced coupling. These data suggest that the development of FM-FHR coupling reflects the development of the central nervous system during gestation, and that development may be affected by maternal factors.

Postoperative orthopaedic blood salvage and reinfusion.

Minimal use of homologous blood is a desirable goal for both patients and health care providers. This article discusses one adjunctive technique that is used for the orthopaedic patient, postoperative blood salvage and reinfusion, and the implications for nurses.

Sex-specific associations of maternal prenatal testosterone levels with birth weight and weight gain in infancy.

Associations between maternal salivary testosterone at 36 weeks' gestation with birth weight and infant weight gain through 6 months of age were examined in a group of 49 healthy, pregnant women and their offspring. The diurnal decline of maternal testosterone was conserved in late pregnancy, and levels showed significant day-to-day stability. Elevated maternal morning testosterone level was associated with lower birth weight Z-scores adjusted for gestational age and sex, and greater infant weight gain between birth and 6 months. Although maternal testosterone levels did not differ by fetal sex, relations were sex-specific such that maternal testosterone had a significant impact on weight for male infants; among female infants associations were nonsignificant. Results highlight the opposing influence of maternal androgens during pregnancy on decreased growth in utero and accelerated postnatal weight gain.

Fetal growth in Peru: comparisons with international fetal size charts and implications for fetal growth assessment.

OBJECTIVES: To compare fetal biometry measurements obtained in a Peruvian population with reference fetal size charts obtained in Peruvian and non-Peruvian populations. METHODS: Fetal biometry measurements collected prospectively in 195 uncomplicated pregnancies were included in the presented analysis. At 20, 24, 28, 32, 36 and 38 weeks' gestation, fetal head circumference, abdominal circumference and femur diaphysis length were measured. Fetal biometry measurements were compared with fetal size charts obtained from another Peruvian and two non-Peruvian populations from North America and Europe. RESULTS: When compared with ultrasound-based reference fetal size charts obtained from North American and European populations, fetuses from the studied population appeared to grow more slowly with advancing gestational age. This trend was not observed when a Peruvian population, similar to the one studied here, was used as a reference. CONCLUSIONS: The results suggest that fetal growth in this Peruvian population may not be adequately assessed by using reference charts obtained from other populations and have implications for the use of growth standards in antenatal management.

Increase in ambient temperature may explain decrease in amniotic fluid index.

In the third trimester, the amniotic fluid index (AFI) may be affected by maternal fluid status. As the ambient temperature increases, there is an increase in insensible fluid loss and the potential for dehydration. We hypothesize that as temperature increases there would be a concomitant decrease in AFI. From June 11 to August 16, 1993, during a period of unusual high heat, 42 women with singleton pregnancies between 27 and 40 weeks' gestation undergoing serial antenatal testing had AFI determinations recorded at least weekly. The daily high ambient temperature in our urban area was subsequently obtained. A 2-, 3-, and 4-day mean temperature prior to the test date was compared to AFI using a Spearman-rank Correlation. The daily high temperature ranged from 71 to 104 degrees F and AFI values ranged from 1.7 to 24.7 cm during the study period. There was a significant correlation between the 2-, 3-, and 4-day mean temperature and AFI, with the 4-day mean being the most significant (r = 0.31, p < 0.001). Fluctuations in ambient temperature are inversely correlated to changes in AFI. This relationship should be taken into account when interpreting the AFI as a measure of fetal well-being.

Fetal movement detection: comparison of the Toitu actograph with ultrasound from 20 weeks gestation.

OBJECTIVE: This study evaluates the validity of Doppler-detected fetal movement by a commercially available monitor and investigates whether characteristics of maternal body habitus and the intrauterine environment affect its performance. METHODS: Fetal movement was evaluated in normal pregnancies using both ultrasound visualization and a fetal actocardiograph (Toitu MT320; Tofa Medical Inc., Malvern, PA). Data were collected for 32 min on 34 fetuses stratified by gestational age (20-25 weeks; 28-32 weeks; 35-39 weeks). Fetal and maternal characteristics were recorded. Comparisons between ultrasound-detected trunk and limb movements and actograph records were conducted based both on 10-s time intervals and on detection of individual movements. RESULTS: Time-based comparisons indicated agreement between ultrasound and actograph 94.7% of the time; this association rose to 98% when movements of less than 1 s duration were excluded. Individual movements observed on ultrasound were detected by the actograph 91% of the time, and 97% of the time when brief, isolated movements were excluded. The overall kappa value for agreement was 0.88. The actograph was reliable in detecting periods of quiescence as well as activity. These findings did not vary by gestational age. The number of movements detected by the actograph, but not the single-transducer ultrasound, significantly increased over gestation. Maternal age, parity, weight, height, or body mass index were not consistently associated with actograph validity. Characteristics of the uterine environment, including placenta location, fetal presentation, and amniotic fluid volume also did not affect results. CONCLUSIONS: The Toitu actograph accurately detects fetal movement and quiescence from as early as 20 weeks gestation and has utility in both clinical and research settings. Actographs are most useful for providing objective and quantifiable measures of fetal activity level, including number and duration of movements, while visualization through ultrasound is necessary for studies of movement quality, source, or mechanics.

Antenatal origins of individual differences in heart rate.

This study examines prenatal-to-postnatal stability in heart rate and variability from mid-gestation through the first year of life. Fetal heart rate data were collected from 52 healthy fetuses at 24, 30, and 36 weeks gestation, and again at 2 weeks and 12 months of age. Fetal heart rate measures were stable during gestation and positively associated with neonatal and infant measures. Maternal pulse rate and oxygen saturation were moderately associated with fetal heart rate. Together, fetal cardiac (heart rate and variability) and maternal physiologic measures (blood pressure and oxygen saturation) explained 40 and 48% of the variance in heart rate and variability, respectively, at 1 year of age. These common measures of individual differences in autonomic function are enduring characteristics that originate during fetal development.

Fetal antecedents of infant temperament.

This study established the emergence of stable individual differences in neurobehavioral functioning prior to birth and examined their relation to subsequent infant temperament. Fetal heart rate and movement were recorded longitudinally for 31 fetuses at 6 gestational ages beginning at 20 weeks' gestation. Maternally reported temperament data were collected at 3 and 6 months. Moderate stability in all measures except reactivity was apparent at some time before birth. By 36 weeks, fetal neurobehavior accounted for between 22% and 60% of the variance in prediction of temperament scores. In general, more active fetuses were more difficult, unpredictable, unadaptable, and active infants. Higher fetal heart rate was associated with lower emotional tone, activity level, and predictability. We conclude that features of fetal neurobehavior provide the basis for individual differences in reactivity and regulation in infancy.

Cross-correlation of fetal cardiac and somatic activity as an indicator of antenatal neural development.

OBJECTIVE: In this study, we wanted to model the emergence of coupling between fetal cardiac and somatic activity in normal and at-risk fetuses. STUDY DESIGN: One hundred six fetuses of uncomplicated pregnancies were longitudinally monitored at 20, 24, 28, 32, 36, and 38 weeks of gestation by using a fetal actocardiograph and computerized data collection. Twenty-six fetuses of complicated pregnancies were also included. Statistical time series analysis techniques were used to examine the relation between fetal movement and fetal heart rate. RESULTS: A linear increase was found in the magnitude of the cross-correlation function between fetal movement and fetal heart rate as gestation advanced, with coalescence around a peak lag of 5 seconds by 32 weeks. Fetuses that delivered before term evidenced accelerated fetal movement and fetal heart rate coupling, whereas fetuses affected by deleterious conditions showed a decline in developmental trajectory. CONCLUSIONS: The cross-correlation between fetal cardiac and somatic activity is an indicator of neuroregulation in human fetuses.

Fetal neurobehavioral development: associations with socioeconomic class and fetal sex.

This longitudinal study investigated neurobehavioral development in the human fetus from 24 to 36 weeks gestation. Subject (N=103) were stratified by socioeconomic class. Fetal data were collected for 50 min at three intervals, and included measures of heart rate, movement, and biobehavioral patterns. Repeated measures analysis of variance by fetal sex and maternal socioeconomic status was used to detect maturation effects and group differences. With advancing gestation, fetuses exhibited reduced heart rate, increased heart rate variability and coupling between movement and heart rate, increased movement vigor, and more biobehavioral concordance. Male fetuses displayed higher heart rate variability throughout gestation and somewhat earlier emergence of biobehavioral organization than females. Fetuses of women of lower socioeconomic status had reduced heart rate variability, moved less often and with less vigor, showed less coupling between movement and heart rate, and had fewer episodes of synchronous quiescence/activity. Results are discussed in terms of development of the central nervous system.

Fetal neurobehavioral development.

The ontogeny of fetal autonomic, motoric, state, and interactive functioning was investigated longitudinally in a sample of 31 healthy fetuses from 20 weeks through term. Fetal heart rate and movement data were collected during 50 min of doppler-based fetal monitoring at 6 gestational ages. Measures of fetal heart rate and variability, activity level and vigor, behavioral state, and reactivity were derived from these digitized data. Weighted least squares analyses were conducted to model the developmental patterns and to examine the role of maternal and fetal covariates. With advancing gestation, fetuses displayed slower heart rate, increased heart rate variability, reduced but more vigorous motor behavior, coalescence of heart rate and movement patterns into distinct behavioral states, and increasing cardiac responsivity to stimulation. Male fetuses were more active than female fetuses, and greater maternal stress appraisal was associated with reduced fetal heart variability. An apparent period of neurobehavioral transition exists between 28 and 32 weeks. Fetal research methods are evaluated.