title: Fetal behavior assessed in all three trimesters of normal pregnancy by four-dimensional ultrasonography.
abstract: OBJECTIVE
  To assess fetal behavior in all three trimesters of normal pregnancy and to investigate the continuation of behavior from fetal to neonatal period.
  
  
  METHODS
  One hundred out of 130 pregnant women in all trimesters with singleton pregnancy were assigned for the investigation. All recordings were performed in the morning, after two hours of fasting. Video recordings of newborns were made while the newborns were in bed, separated from other infants in the nursery, dressed, and lying on their backs in a supine position with unrestrained hands. Recording was not performed during prolonged episodes of fussing and crying, during drowsiness, and episodes of hiccupping. All observed facial expressions and movement patterns were presented collectively with maximum, minimum, and median frequencies during 30-minute observation period.
  
  
  RESULTS
  We noted a tendency towards decreased frequency of facial expressions and movement patterns with increasing gestational age. In the first trimester, we observed the highest incidence of general movements ranging between 5 and 147, and with a median value of 47. In the second trimester, the number of head and hand movements decreased gradually, compared with the first trimester. The highest range was registered for head retroflexion pattern, ranging from 15 to 42 with a median of 25. The most frequent facial pattern in the second trimester was sucking (3 and 30 movements per infant with a median value of 9). Wilcoxon rank-sum test showed statistically significant differences between the fetuses in the third trimester and the newborns (P<0.05) in hand to head, hand to mouth, hand to eye, hand to ear movement), tongue expulsion, and smiling, whereas the differences between the rest of the movements were not statistically significant. Spearman rank order correlation reached statistical significance (P<0.05) in isolated eye blinking, smiling, grimacing, hand to head, hand to mouth, hand to eye, hand to face, and in hand to ear movement, whereas the differences between the rest of the facial expressions were not statistically significant.
  
  
  CONCLUSIONS
  Fetal behavioral patterns directly reflect the developmental and maturational processes of the central nervous system. 4D observation of fetal and early neonatal period may add to better understanding of the neurological development of the fetus.
authors.affiliation: Department of Obstetrics and Gynecology, Zagreb University Medical School, Holy Ghost General Hospital, Sveti Duh 64, Zagreb, Croatia. asim.kurjak@public.srce.hr
authors.forename: Asim
authors.initials: A
authors.lastname: Kurjak
authors.forename: Milan
authors.initials: M
authors.lastname: Stanojevic
authors.forename: Wiku
authors.initials: W
authors.lastname: Andonotopo
authors.forename: Elena
authors.initials: E
authors.lastname: Scazzocchio-Duenas
authors.forename: Guillermo
authors.initials: G
authors.lastname: Azumendi
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Carrera
mesh_terms: D019561:Echocardiography, Four-Dimensional; D004453:Echoencephalography; D005149:Facial Expression; D005260:Female; D005324:Fetal Movement; D006801:Humans; D011247:Pregnancy; D011264:Pregnancy Trimesters; D011446:Prospective Studies; D016216:Ultrasonography, Prenatal / Q000379:methods*; D014741:Video Recording