Fetal brain magnetic resonance imaging and long-term neurodevelopmental impairment

Objective

To determine the incidence of fetal brain injury by fetal brain magnetic resonance imaging (MRI) in pregnancies complicated with preterm labor (PL), preterm premature rupture of the membranes (PPROM), and intrauterine growth restriction (IUGR), and to compare fetal brain MRI with prenatal surveillance methods, and with immediate and long-term neurodevelopmental outcome.

Methods

Between February 2007 and January 2009, high-risk pregnancies were analyzed by MRI at 1.5 Tesla after 24 weeks of gestation at the Clinical Hospital Center Zagreb, Croatia. Long-term outcome was defined as neurodevelopmental outcome at 24 months.

Results

Among 70 pregnancies analyzed, 40.0% had abnormal fetal brain MRI. The highest incidence occurred in the PL group. There was no correlation between abnormal MRI and fetal surveillance methods (ultrasound, Doppler blood flow analysis, cardiotocography, biophysical profile) or immediate neonatal outcome (1-minute Apgar score, umbilical cord pH). Via MRI, fetal brain injury would have been diagnosed for 45.7% of fetuses with a long-term neurodevelopmental handicap. Binary logistic regression showed that, as compared with other surveillance methods, fetal brain MRI was the best predictor of long-term neurodevelopmental disability.

Conclusion

PL, IUGR, and PPROM were associated with an early intrauterine CNS insult that was not accurately detected by existing prenatal testing options.     

Prenatal diagnostic rates and postnatal outcomes of fetal orofacial clefts in a Taiwanese population

Objective

To report the incidence, prenatal diagnostic rate, and postnatal outcomes of fetal orofacial cleft at a tertiary referral center in Taiwan.

Methods

The demographic data, maternal and fetal characteristics, and postnatal outcomes for fetuses with cleft lip and/or cleft palate (CL/P) born between January 1998 and December 2008 at Chang Gung Memorial Hospital, Taipei, were reviewed retrospectively, and diagnostic rates were evaluated according to cleft type.

Results

Among 26 499 deliveries, 84 were affected with CL/P. The mean maternal age and gestational age at detection of CL/P were 30.37 years (range 21-41 years) and 24.7 weeks (range 18-33 weeks), respectively. Thirty-one fetuses had associated structural anomalies, 5 of which involved chromosomal aberrations. CL/P was diagnosed prenatally for 74 (88%) fetuses. After consultations, 17 pregnancies (20%) were aborted. The postnatal survival rate was 95.5% (64/67 infants). The type of cleft had a significant influence on correct prenatal diagnosis (P < 0.001).

Conclusion

For fetuses diagnosed prenatally with an orofacial cleft, access to an experienced craniofacial team, well-planned delivery, and pediatric intensive care led to favorable postnatal outcomes after lethal malformations were excluded through detailed sonographic and chromosomal evaluations.     

The effect of routine magnesium supplementation on fetal cardiac time intervals: a fetal magnetocardiographic study

Objectives

Magnesium deficiency in pregnancy is frequent, and in consequence magnesium supplementation is widely used. As magnesium crosses the placental barrier and since the fetal kidney does not excrete magnesium as efficiently as the mature kidney, effects on fetal cardiac time intervals are probable, but still unknown.

Study design

Sixty pregnant women were included in an observational study: 31 patients received oral routine magnesium supplementation. In addition to routine fetal echocardiography, fetal magnetocardiography (fMCG) was used to investigate electrophysiological rhythm patterns with high temporal resolution. fMCG tracings were analyzed according to a predefined procedure for fetal cardiac time interval (CTI)-detection. fCTI findings (P-wave, PQ-segment, PR-interval, QRS complex, ST segment, T-wave and QTc interval) were registered.

Results

Significant widening of the QRS-complex (p = 0.004) was demonstrated in fetuses whose mothers received magnesium supplementation (240 mg/day) relative to the control group.

Conclusion

Magnesium exposed fetuses demonstrated a prolonged ventricular arousal, but healthy neonatal outcome was found in all exposed fetuses. Although fMCG is a preclinical method and limited in its availability, the procedure could help to monitor fetuses.     

Perinatal outcome after ultrasound prenatal diagnosis of persistent right umbilical vein

Objective

Our aim was to describe ultrasound findings and perinatal outcome after prenatal diagnosis of persistent right umbilical vein (PRUV).

Study design

We performed a retrospective analysis of fetuses with an ultrasound-based prenatal diagnosis of PRUV on record at 2 tertiary centers in Madrid, Spain. We describe clinical, maternal, fetal and perinatal variables for all cases.

Results

A total of 20,426 fetuses were delivered between the study centers. We detected 22 cases (0.1%) of PRUV. The male-to-female ratio was 1:1. All cases were intrahepatic type and diagnosed during the second and third trimesters (median, 21 weeks; IQR, 20–29 weeks). Doppler ultrasound revealed normal flow in the ductus venosus in all cases. Nine fetuses (40.9%) had additional ultrasound anomalies but no chromosomal abnormalities. Cardiovascular malformations were the most frequently associated congenital anomalies (4/9), followed by neurological malformations (2/9). In 5 of the cases with no concomitant anomalies, the weight of the newborn was below the tenth percentile for gestational age. Gestational development was normal for the remaining newborns. Delivery was unremarkable, and post-natal evolution was favorable.

Conclusion

Our results point to a potential association between PRUV and other fetal malformations and a very low rate of chromosomal abnormalities. Prenatal diagnosis of PRUV should be followed by detailed anatomical evaluation and echocardiography in order to rule out other structural malformations. The indication for a fetal karyotype study must be made on an individual basis considering PRUV type and other ultrasound findings.     

Cardiac findings in routine fetal autopsies: more than meets the eye?

Objective

The main objective of this study was to evaluate the spectrum of cardiac anomalies found in routinely performed fetal autopsies and to establish the correlation between prenatal and postmortem diagnosis.

Study design

A retrospective study of fetal autopsies was performed. Cases with cardiac anomalies were analyzed. Seven main categories were established and each case was assigned to a single group. Cardiac defects were also classified as isolated or with associated anomalies. In the cases with prenatal diagnosis, we performed a correlation between prenatal and postmortem findings.

Results

Abnormal cardiac findings were identified in 99 fetuses (13.6%). The two most common categories were septal defects and complex anomalies, each occurring in 21 fetuses (21.2%). Sixty-seven (67.7%) had associated anomalies. Septal anomalies were more frequent in cases with associated anomalies (p = 0.012). Prenatal diagnosis had been performed in 50 cases. There was complete agreement between prenatal and postmortem diagnosis in 36 cases (72%), and major agreement with additional information in ten (20%). When the echocardiogram was not performed by a specialist, the number of cases classified with complete disagreement was higher (33.3% vs 2.4%) (p = 0.002).

Conclusion

The high prevalence of cardiac defects in lost pregnancies, some of them lacking prenatal diagnosis, highlights the importance of examining the heart in all cases.     

A cohort study of Plasmodium falciparum malaria in pregnancy and associations with uteroplacental blood flow and fetal anthropometrics in Kenya

Objective

To use ultrasound to explore the impact of malaria in pregnancy on fetal growth and newborn outcomes among a cohort of women enrolled in an intermittent presumptive treatment in pregnancy (IPTp) with sulfadoxine/pyrimethamine (SP) program in coastal Kenya.

Methods

Enrolled women were tested for malaria at first prenatal care visit, and physical and ultrasound examinations were performed. In total, 477 women who had term, live births had malaria tested at delivery and their birth outcomes assessed, and were included in the study.

Results

Peripheral malaria was detected via polymerase chain reaction among 10.9% (n = 87) at first prenatal care visit and 8.8% (n = 36) at delivery. Insecticide-treated bed nets (ITNs) were used by 73.6% (n = 583) and were associated with decreased malaria risk. There was a trend for impaired fetal growth and placental blood flow in malaria-infected women in the second trimester, but not later in pregnancy. Among women with low body mass index (BMI), malaria was associated with reduced birth weight (P = 0.04); anthropometric measures were similar otherwise.

Conclusion

With IPTp-SP and ITNs, malaria in pregnancy was associated with transient differences in utero, and reduced birth weight was restricted to those with low BMI.     

Accuracy of sonographic fetal weight estimation of fetuses with a birth weight of 1500 g or less

Objective

To compare 35 commonly used formulae for small and average sized fetuses on their accuracy in estimating the birth weight in fetuses of 1500 g or less.

Study design

For this retrospective study a database search was performed for all singleton pregnancies without structural or chromosomal defects and with a birth weight of 1500 g or less where the last ultrasound examination was performed within seven days before delivery. Percentage error and absolute percentage error were calculated based on 35 different weight estimation formulae. Multiple regression analysis was used to determine the significant contributors to the absolute percentage error.

Results

One hundred and ninety-three cases fulfilled the inclusion criteria. The median birth weight was 990 g. The percentage error ranged between −15.2% (underestimation with the Merz I formula) and 37.4% (overestimation with the Jordaan formula) and the respective standard deviations between 10.5% (Mielke I) and 54.0% (Schillinger), respectively. The absolute percentage error was between 8.5% and 37.6%. The most accurate weight estimation was achieved with the formula from Mielke (percentage error 1.8% and absolute percentage error 8.5%). Multiple regression analysis showed that significant contributors to the percentage error of the Mielke formula were biparietal diameter (OR = −0.206, p = 0.045), occipitofrontal diameter (OR = 0.765, p < 0.0001), abdominal circumference (OR = −2.953, p < 0.0001), femur length (OR = −0.903, p < 0.0001), head to abdomen ratio (OR = −1.080, p < 0.0001) and fetal weight (OR = 2.847, p < 0.0001).

Conclusion

When estimating fetal weight in fetuses weighing 1500 g or less, one has to be aware of the great differences in accuracy among the formulae.     

Ultrasound score: a new method to differentiate fetal physiological and pathological hydronephrosis

Objective

To determine whether the prenatal ultrasound (US) score can effectively differentiate fetal physiological and pathological hydronephrosis.

Study design

158 fetuses (198 kidneys) with hydronephrosis (PAPD ≥ 10 mm) were diagnosed by prenatal US in the third trimester. We measured and recorded three US parameters: renal pelvic anterior posterior diameter (PAPD), renal parenchyma thickness and pelvicaliceal morphology. They were graded with a score from 0 to 3 on the basis of severity of hydronephrosis, and the total US score of each kidney was obtained. According to the postnatal US and clinical diagnosis and management, all the cases were divided into two groups: physiological and pathological hydronephrosis. Using receiver operating characteristic curves analysis, we researched whether the US score was more accurate than each parameter and which was the best cut-off value for differential diagnosis of physiological and pathological hydronephrosis.

Results

Of all the 198 hydronephrosis, 139 (70.20%) were physiological and 59 (29.80%) were pathological confirmed postnatally. Area under the curve of US score was 0.982, which was significantly larger than that of each parameter (P < 0.05). The higher the score, the higher the possibility of pathological hydronephrosis was. Score 6 was the best cut-off value: the sensitivity, specificity, positive predictive value, negative predictive value, consistency rate and Youden's index were 89.83%, 94.24%, 86.89%, 95.62%, 92.93% and 0.8407, respectively.

Conclusion

Prenatal US score is easy to obtain by measuring some data of the kidney and can effectively differentiate fetal physiological and pathological hydronephrosis. It can also be used as a new quantitative method to evaluate the prognosis of fetal hydronephrosis so as to provide reference for prenatal intervention and more accurate information for the family of the fetus.     

Idiopathic urinary findings and fetal growth restriction in low risk pregnancy

Objective

To determine whether maternal urinary findings in the first trimester of pregnancy are associated with fetal growth restriction.

Study design

The prevalence of urinary findings in singleton pregnancies complicated by fetal growth restriction were compared with a low-risk control group of pregnancies who gave birth to normal weight babies, in the same condition.

Results

There were significant statistical differences in the mean gestational age (p < 0.001), isolated asymptomatic bacteriuria (p < 0.001), hematuria (p = 0.002, OR = 6.6, CI = 1.8–24.2) and proteinuria (p = 0.016, OR = 4.1, CI = 1.2–13.3). There was no recognizable relation between ketonuria and fetal growth restriction.

Conclusion

Our data showed a relation between the increase of adverse pregnancy outcomes, including fetal growth restriction, and hematuria, proteinuria and asymptomatic bacteriuria. Appropriate monitoring of pregnant women using these findings may be helpful in the identification of more complications.     

Study of fetal tracheal fluid velocities using Doppler ultrasound

Objective

To characterize tracheal fluid flow during fetal breathing movements by Doppler ultrasound.

Study design

To use pulsed Doppler to measure flow velocity during inspiration and expiration in a cross-sectional study of 15 normal fetuses and determine the correlation, if any, between flow velocity and gestational age.

Results

Cyclic respiratory profiles – both regular and irregular – were observed. Intratracheal flow velocity was very elevated during inspiration, ranging from 10 to 80 cm/s and from 5 to 20 cm/s during expiration.

Conclusion

This technique enables the noninvasive semiquantitative evaluation of fetal breathing movements. This Doppler application opens the field for future studies to characterize the extent of pulmonary hypoplasia.     

Prediction of lethal pulmonary hypoplasia among high-risk fetuses via 2D and 3D ultrasonography

Objective

To compare accuracy between 3D and 2D ultrasonography for predicting lethal pulmonary hypoplasia (LPH) among high-risk fetuses.

Methods

In a cross-sectional prospective study at a fetal medicine referral center in Brazil, bilateral fetal lung scans were evaluated for 54 fetuses with suspected LPH between May 2008 and June 2011. Measurements for predicting LPH were ultrasonographic fetal lung volume/estimated fetal weight ratio (US-FLW), observed/expected thoracic circumference (o/e-TC), observed/expected thoracic circumference/abdominal circumference (o/e-TC/AC), observed/expected thoracic area/heart area (o/e-TA/HA), observed/expected amniotic fluid index (o/e-AFI), and observed/expected total fetal lung volume (o/e-Tot-FLV). To evaluate accuracy in predicting LPH, receiver operating characteristic (ROC) curves were calculated, and areas under the curves (AUCs) were compared. The intraclass correlation coefficient (ICC) was used to assess 3D lung volume reproducibility.

Results

Data were compared for 47 newborns, of whom 34 had LPH (perinatal mortality 74.5%). The AUCs for predicting LPH were 0.93, 0.69, 0.55, 0.46, 0.71, and 0.86 for US-FLW, o/e-TC, o/e-TC/AC, o/e-TA/HA, o/e–AFI, and o/e-Tot–FLV, respectively. No significant intraobserver difference was observed in measurements of the right (ICC, 0.973; P < 0.0001) or left (ICC, 0.950; P < 0.0001) lung volumes.

Conclusion

Among high-risk fetuses, US-FLW by 2D/3D and o/e-Tot-FLV by 3D ultrasonography were more accurate than 2D parameters for predicting LPH.     

A combination of umbilical artery PI and normalized blood flow volume in the umbilical vein: Venous–arterial index for the prediction of fetal outcome

Objective

The objective was to assess the diagnostic power of the umbilical venous–arterial index (VAI) as a combination of the pulsatility index in the umbilical artery and the normalized blood flow volume in the umbilical vein for the prediction of poor fetal outcome.

Study design

This was a prospective clinical study in which the umbilical artery PI (UAPI), the normalized umbilical vein blood volume flow rate (nUV; ml/min/kg estimated fetal body weight), the venous–arterial index (VAI; nUV/UAPI), and the pulsatility index (PI) in the umbilical artery (UA), uterine artery (utA), middle cerebral artery (MCA), and aorta were determined in 181 fetuses once (at between 17 and 41 weeks’ gestation) during pregnancy using standard Doppler ultrasound equipment. A risk score based on the umbilical blood pH, the 1 min Apgar score, birth weight, duration of gestation, type of postpartum respiratory support, and referral to the pediatric department was used, and fetuses were assigned to a control or a pathological group accordingly.

Results

The incidence of compromised neonates was 18.2%. The sensitivity of the UAPI in predicting the poor neonatal outcome was 51.5%, of the nUV 54.5%, the MCA PI 39.4%, the PI in the utA 61.5%, and the notching in the utAa and the VAI was 57.6% and 69.7% respectively.

Conclusion

A combination of the umbilical artery PI and the nUV as the VAI with a cut-off of 100 ml/min/kg can be used to predict fetal outcome.     

Operator experience reduces the risk of second trimester amniocentesis-related adverse outcomes

Objective

To investigate the impact of operator experience on amniocentesis-related adverse outcomes.

Study design

Retrospective study of mid-trimester amniocenteses performed by the same operator on singleton pregnancies in a single private institution during 1994–2007. Outcomes were hemorrhagic or dark amniotic fluid aspiration, insufficient volume aspiration, repeated puncture and fetal loss. Rates were estimated annually, as well as for every 10% of procedures up to the total number. The association of each outcome with epidemiological aspects was also examined.

Results

In total, 5913 amniocenteses were performed. The overall rate of adverse outcomes was 5.4%. The total adverse outcome rate reduced from 10.2% in the first 10% of cases to 3.0% in the last 10% (P = .001). The rate of hemorrhagic fluid gradually decreased from 4.4% to 1.5% (P = .05) over the same intervals. The fetal loss rate was also reduced from 0.5% during the first half to 0.3% in the second half of the study period (P = NS). Logistic regression analysis indicated no significant correlations between adverse outcomes with any of epidemiological parameters of women undergoing amniocentesis.

Conclusion

Operator experience has a beneficial impact on preventing procedure-related adverse outcomes.     

Assessment of the female fetal DNA concentration in the plasma of the pregnant women as preeclampsia indicator—Preliminary report

Objectives

This research was designed to analyze the presence of fetal female DNA, expressed in copy number, in the plasma of the pregnant woman with preeclampsia-complicated pregnancy.

Study design

Twenty-four pregnant women with female fetuses identified by means of ultrasound scanning were enrolled in this pilot study. The study group consisted of 12 pregnant women with symptoms of preeclampsia, with 12 healthy women, matched for gestational age, as controls.

Results

Mean DNA number of genomic equivalents per reaction in the group was 201 geq/PCR (from 44.9 to 375) and increased over time after onset of PE, which was the reason for pregnancy termination. In the group of women with preeclampsia, a notably higher DNA copy number in comparison to the control group was noted (p = 0.0003 U Mann–Whitney test).

Conclusions

The pilot study presented in this work confirms that also in the case of preeclampsia-complicated pregnancy with female fetuses it is possible to implement the method of fetal DNA quantification. Use of the presented methods confirms that in severe preeclampsia-complicated pregnancies an increase of the number of DNA genomic equivalents per reaction in comparison to the control group is observed. Due to the small study group further research on the described issue is vital, but this study proves that it is also feasible among women carrying female fetuses.     

Prenatal diagnosis of Prader–Willi syndrome and Angelman syndrome for fetuses with suspicious deletion of chromosomal region 15q11-q13

Objective

To identify Prader–Willi syndrome (PWS) and Angelman syndrome (AS) among fetuses with suspicious deletion of the chromosomal region 15q11-q13.

Methods

In a retrospective study, data were assessed from fetuses missing chromosomal band 15q12 that underwent molecular diagnosis at the National Chen-Kung University Hospital, Tainan, Taiwan, between January 2001 and December 2012. Amniocytes were subjected to molecular testing, including fluorescence in situ hybridization (FISH) analysis, methylation-specific PCR (M-PCR), and methylation-specific multiplex-ligation-dependent probe amplification (MS-MLPA).

Results

During the 12-year study period, 26 041 amniocyte samples were analyzed at the study center and 27 (0.1%) were found to have a missing 15q12 band. A further 16 samples with a missing 15q12 band were received from other cytogenetic laboratories; as a result, 43 amniocyte samples lacking chromosomal band 15q12 underwent further molecular testing. Among these samples, 3 fetuses (7.0%) were found to have PWS (n = 1) or AS (n = 2).

Conclusion

A minority of cases with missing 15q12 had deletion of the PWS/AS critical region. This finding draws attention to the subtle structural rearrangements that occur on 15q11-q13 and provides useful information for prenatal diagnosis of PWS and AS.     

Conotruncal anomalies in fetal life: Accuracy of diagnosis, associated defects and outcome

Objectives

To assess the accuracy of prenatal echocardiography, associated anomalies, and outcome of fetuses with conotruncal anomalies (CTA).

Study design

We searched our database for CTA prenatally diagnosed between 1990 and 2005. We included tetralogy of Fallot (TOF), transposition of the great arteries (TGA), double-outlet right ventricle (DORV), truncus arteriosus (TA), pulmonary atresia with ventricular septal defect (PA-VSD) and posterior malalignment type VSD with aortic arch obstruction (pmtVSD-AAO). Data of 144 fetuses with complete follow-up were retrieved and analyzed.

Results

The main reason for referral was suspected heart defect on a routine obstetric scan (72%). Most cases were detected ≤22 weeks (55%). The presence of a CTA was confirmed postnatally in 143 cases (99%), and the diagnosis of the first fetal echocardiography was correct in 126 (87.5%). Most diagnosis of TOF (33/36, 91.7%), TGA (34/38, 89.5%) and DORV (34/38, 89.5%) were proved correct. Inadequate assessment of the interventricular septum, the distal aortic arch and/or the severity of the right outflow tract obstruction accounted for most errors. The accuracy rate was lower in TA (11/14, 78.6%) and PA-VSD (4/7, 57.1%), with evaluation of the branch pulmonary arteries as the main source of discrepancies. In 7/18 incorrect cases subsequent scans allowed to obtain a correct diagnosis. Most fetuses (64%) had an isolated CTA. Thirty-seven had chromosomal anomalies (26%) but none were found in TGA. 22q11 deletion affected 8.7% of the tested patients. Nuchal translucency (NT) was above 95th centile in 19/104 cases (18%) in which NT were measured. Fifty cases were interrupted. The overall one-year survival rate was 71%, with differences between cases with and without associated defects (9/25, 36% vs. 57/68, 83.8%; p < 0.01). The uncomplicated forms of TGA and TOF had the best survival rates (100%).

Conclusions

Most CTA can be diagnosed by fetal echocardiography with a high degree of accuracy. Chromosomal defects should always be ruled out, except for simple TGA. Current survival figures in many isolated CTA, especially simple TGA and TOF, support a change in the “classical” concept that congenital heart defects detected prenatally often have the worst outlook.

Condensation

Most CTA can be diagnosed by fetal echocardiography with a high degree of accuracy. Isolated CTA are more common and most of these may have a favourable outcome.     

Small-for-gestational-age fetuses with normal umbilical artery Doppler have suboptimal perinatal and neurodevelopmental outcome

Objective

To evaluate the perinatal and neurodevelopmental outcome of small-for-gestational-age fetuses with normal umbilical artery Doppler managed expectantly during pregnancy and delivery.

Study design

Perinatal and neurodevelopmental outcome was assessed from a cohort of singleton small-for-gestational-age fetuses with normal umbilical artery Doppler and normally grown controls matched by gestational age at delivery, parity and parental socio-economic level. Neurodevelopmental outcome was prospectively evaluated by means of the 24-month Age&Stage Questionnaire (ASQ).

Results

A total of 129 small-for-gestational-age fetuses and 259 controls were included. Small-for-gestational-age fetuses had a higher risk for neonatal intensive care unit admission (15.5% versus 3.9%; p < 0.001) and significant neonatal morbidity (2.3% versus 0%; p = 0.04) than controls. At 24-months, these fetuses showed significantly lower neurodevelopmental centile in the problem solving (42.8 versus 52.1; p = 0.001) and personal-social (44.4 versus 54.6; p < 0.001) areas than controls.

Conclusion

Perinatal and neurodevelopmental outcome in small-for-gestational-age fetuses with normal umbilical artery Doppler is suboptimal, which may challenge the role of umbilical artery Doppler to discriminate between normal-SGA and growth-restricted fetuses.     

Enfermedad renal: urinoma. A propósito de un caso

Objective

Fetal ultrasound enables us to diagnose and follow the progress of obstructive uropathies including the occurrence of fetal urinomas.

Subject and methods

We report a case of hydronephrosis diagnosed in the second trimester with evolution urinoma.

Results

Patient at 21.4 weeks’ gestation showed in fetal ultrasound a left hydronephrosis grade II. At 27.5w showed a left hydronephrosis with a retroperitoneal fluid collection perirenal 40 × 50 × 30 mm and distortion of the kidney morphology compatible with urinoma.

Conclusions

the prenatal occurrence of an urinoma is often associated with the postnatal absence of function of the involved kidney.     

4D ultrasound study of fetal facial expressions at 20–24 weeks of gestation

Objective

To assess the frequency of fetal facial expressions at 20–24 weeks of gestation using four-dimensional (4D) ultrasonography and to determine whether there was any correlation between facial expression and gestational age (20–34 weeks).

Methods

The facial expressions of 23 healthy fetuses were examined using 4D ultrasound at 20–24 weeks. Each fetus was recorded continuously for 15 minutes. The frequencies of mouthing, yawning, smiling, tongue expulsion, scowling, sucking, and blinking were assessed and the data combined with those expressions observed at 25–34 weeks of gestation in two previous studies (n = 34) to determine the correlation between gestational age and each of the facial expressions.

Results

Mouthing was significantly more frequent than the other six facial expressions at 20–24 weeks (P < 0.05). Yawning was significantly more frequent than smiling, scowling, and blinking (P < 0.05), and sucking was significantly more frequent than smiling, scowling, and blinking (P < 0.05). The frequency of yawning, smiling, tongue expulsion, scowling, and blinking increased with gestational age (P < 0.05). Mouthing movement and sucking frequencies remained constant between 20 and 34 weeks.

Conclusion

Frequencies of complicated facial expressions such as smiling and scowling may increase with advancing gestation owing to the development of the fetal brain and central nervous system.