de Vries J I P, Fong B F
Department of Obstetrics and Gynaecology, Institute of Fundamental and Clinical Human Sciences, VU University Medical Center, Amsterdam, The Netherlands.
Ultrasound Obstet Gynecol. 2007 May;29(5):590-9. doi: 10.1002/uog.3917.
After 35 years of real-time two-dimensional sonography, can we now identify changes in fetal motility indicative of malfunction of the central nervous system in high-risk pregnancies? A literature search on motor assessment procedures (movements specified for body part (SMP), quantity, quality and behavioral state), and motor milestones obtained per fetus (with various congenital disorders) yielded 48 articles describing motility of 104 fetuses. In 67%, SMPs (especially isolated arm or leg movements, breathing and general movements) were assessed. Quantitative aspects were examined in 76%, qualitative aspects in 62% and behavioral states in two fetuses. Abnormal motility can be divided into two main subcategories: hypo- and hyperkinetic, demonstrating decreased variation in qualitative performance (reduced or increased, respectively, amplitude, speed and number of participating body parts, abnormal quantity (reduced or increased, respectively) and reduced differentiation into SMPs. Posture was affected in 40/60 hypokinetic and 4/44 hyperkinetic moving fetuses. The majority of the disorders resulted in an adverse outcome. Fourteen percent survived with a handicap, depending on the underlying disorder. The 16 disorders with hypokinetic motility had mainly an autosomal recessive etiology with no possibility of invasive prenatal diagnosis or conclusive sonographic structural anomalies, in contrast to the 17 disorders with hyperkinetic motility. Within the limitations of the studies, a deeper understanding of affected milestones in motor development can be obtained. Broadening motor assessment procedures from quantitative only to include qualitative aspects, differentiation of SMPs and behavioral states and emphasizing onset and continuity of motility before and after birth will enhance the reliability and predictive value of motility as a parameter in the assessment of fetal condition.
在实时二维超声检查应用35年后，如今我们能否识别出高危妊娠中提示中枢神经系统功能异常的胎儿运动变化？一项关于运动评估程序（针对身体部位指定的运动（SMP）、数量、质量和行为状态）以及每个胎儿（患有各种先天性疾病）获得的运动发育里程碑的文献检索，共得到48篇描述104例胎儿运动的文章。67%的研究评估了SMP（尤其是孤立的手臂或腿部运动、呼吸和全身运动）。76%的研究检查了定量方面，62%的研究检查了定性方面，有两项研究检查了行为状态。异常运动可分为两个主要亚类：运动减少和运动增多，表现为定性表现的变化减少（分别为幅度、速度和参与身体部位数量减少或增加，数量异常（分别减少或增加）以及分化为SMP的减少）。40/60例运动减少的运动胎儿和4/44例运动增多的运动胎儿的姿势受到影响。大多数疾病导致不良结局。14%的患儿存活但有残疾，这取决于潜在疾病。与17例运动增多的疾病相比，16例运动减少的疾病主要为常染色体隐性病因，无法进行侵入性产前诊断或发现确凿的超声结构异常。在研究的局限性范围内，可以更深入地了解运动发育中受影响的里程碑。将运动评估程序从仅定量扩展到包括定性方面、SMP的分化和行为状态，并强调出生前后运动的起始和连续性，将提高运动作为评估胎儿状况参数的可靠性和预测价值。
