Maternal and Fetal Health Research Centre, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK.
School of Healthcare, University of Leeds, Leeds LS2 9JT, UK.
Med Hypotheses. 2018 Feb;111:19-23. doi: 10.1016/j.mehy.2017.12.024. Epub 2017 Dec 18.
Changes in fetal movement are associated with increased risk of stillbirth after 28 weeks of pregnancy. The majority of studies have focussed on maternal perception of reduced fetal movements, which is associated with stillbirth via placental dysfunction. Recent studies have also described an association between a single episode of excessive fetal movements and late stillbirth. We present a hypothesis that a sudden episode of excessive fetal activity indicates fetal compromise relating to underlying disturbance of the in utero environment, which if it persists can lead to fetal death. The origin of the excessive fetal movements is unknown; they may represent fetal seizures induced by asphyxia or infection, an attempt to release cord entanglement or a change in fetal behaviour (inducing signs of distress) in response to a noxious stimulus. It is also possible that an increase in maternal anxiety may lead to increased perception of fetal activity. Current evidence regarding excessive fetal movements is sparse; there is no clinical guidance regarding how reporting of this symptom might relate to a fetus at risk and which management might reduce the risk of subsequent stillbirth. This could be addressed by prospective observational studies of mothers presenting with excessive fetal movements which could both explore the underlying pathophysiology and determine which investigations could identify fetal compromise in this population. The presence of fetal seizures or umbilical cord entanglement could be evaluated at the time of presentation by cardiotocography and ultrasonography of the fetus and cord. Exposure to infection or noxious stimuli could be evaluated by maternal history and measurement of maternal blood for inflammatory markers or toxins. Maternal anxiety could be assessed by validated anxiety scores. Fetal outcome following excessive fetal movements can be recorded after birth. In addition, the presence of perinatal asphyxia can be assessed using Apgar scores, assessment of fetal acidaemia or measurement of stress-related factors in umbilical cord blood. The placenta and cord can be systematically examined for signs of hypoxia, infection or umbilical cord compression. Such studies would provide evidence regarding the underlying cause of excessive fetal movement and how this symptom might relate to in utero compromise and stillbirth. Ultimately, this approach will determine whether excessive fetal movements can be used alongside reduced fetal movements as a tool to reduce the perinatal mortality rate.
胎儿运动的变化与 28 周后妊娠的死胎风险增加有关。大多数研究都集中在母体感知到胎儿运动减少上，这与胎盘功能障碍导致的死胎有关。最近的研究还描述了单次胎儿运动过度与晚期死胎之间的关联。我们提出了一个假设，即突然出现的过度胎儿活动表明胎儿受到了潜在的宫内环境紊乱的影响，如果这种情况持续下去，可能会导致胎儿死亡。过度胎儿运动的原因尚不清楚；它们可能代表由窒息或感染引起的胎儿发作，试图释放脐带缠绕或胎儿行为的变化（引起窘迫迹象）以应对有害刺激。也有可能是母体焦虑的增加导致对胎儿活动的感知增加。目前关于过度胎儿运动的证据很少；关于如何报告这种症状可能与高危胎儿有关，以及哪些治疗方法可能降低随后死胎的风险，目前没有临床指导。这可以通过对出现过度胎儿运动的母亲进行前瞻性观察研究来解决，这些研究既可以探索潜在的病理生理学，又可以确定哪些检查可以在这一人群中识别胎儿受损。胎儿发作或脐带缠绕可以通过胎儿和脐带的胎心监护图和超声检查在出现时进行评估。通过母体病史和测量母体血液中的炎症标志物或毒素来评估感染或有害刺激的暴露情况。可以通过经过验证的焦虑评分来评估母体焦虑。可以在分娩后记录胎儿过度运动后的结局。此外，还可以通过使用 Apgar 评分、评估胎儿酸中毒或测量脐带血中应激相关因素来评估围产期窒息的情况。可以对胎盘和脐带进行系统检查，以寻找缺氧、感染或脐带受压的迹象。此类研究将提供有关过度胎儿运动的潜在原因的证据，以及该症状如何与宫内窘迫和死胎有关。最终，这种方法将确定过度胎儿运动是否可以与胎儿运动减少一起作为降低围产儿死亡率的工具。
