Verbruggen Stefaan W, Kainz Bernhard, Shelmerdine Susan C, Arthurs Owen J, Hajnal Joseph V, Rutherford Mary A, Phillips Andrew T M, Nowlan Niamh C
Department of Bioengineering, Imperial College London, London, UK.
Department of Computing, Imperial College London, London, UK.
J Biomech. 2018 Sep 10;78:1-9. doi: 10.1016/j.jbiomech.2018.07.016. Epub 2018 Jul 20.
Fetal kicking and movements generate biomechanical stimulation in the fetal skeleton, which is important for prenatal musculoskeletal development, particularly joint shape. Developmental dysplasia of the hip (DDH) is the most common joint shape abnormality at birth, with many risk factors for the condition being associated with restricted fetal movement. In this study, we investigate the biomechanics of fetal movements in such situations, namely fetal breech position, oligohydramnios and primiparity (firstborn pregnancy). We also investigate twin pregnancies, which are not at greater risk of DDH incidence, despite the more restricted intra-uterine environment. We track fetal movements for each of these situations using cine-MRI technology, quantify the kick and muscle forces, and characterise the resulting stress and strain in the hip joint, testing the hypothesis that altered biomechanical stimuli may explain the link between certain intra-uterine conditions and risk of DDH. Kick force, stress and strain were found to be significantly lower in cases of breech position and oligohydramnios. Similarly, firstborn fetuses were found to generate significantly lower kick forces than non-firstborns. Interestingly, no significant difference was observed in twins compared to singletons. This research represents the first evidence of a link between the biomechanics of fetal movements and the risk of DDH, potentially informing the development of future preventative measures and enhanced diagnosis. Our results emphasise the importance of ultrasound screening for breech position and oligohydramnios, particularly later in pregnancy, and suggest that earlier intervention to correct breech position through external cephalic version could reduce the risk of hip dysplasia.
胎儿的踢动和活动会在胎儿骨骼中产生生物力学刺激，这对产前肌肉骨骼发育，尤其是关节形状的发育很重要。发育性髋关节发育不良（DDH）是出生时最常见的关节形状异常，该病症的许多风险因素都与胎儿活动受限有关。在本研究中，我们调查了在诸如臀位、羊水过少和初产（头胎妊娠）等情况下胎儿活动的生物力学。我们还研究了双胎妊娠，尽管子宫内环境更为受限，但双胎妊娠发生DDH的风险并不更高。我们使用电影磁共振成像（cine-MRI）技术跟踪这些情况下的胎儿活动，量化踢动力和肌肉力量，并描述髋关节产生的应力和应变，检验改变的生物力学刺激可能解释某些子宫内状况与DDH风险之间联系的假设。结果发现，臀位和羊水过少情况下的踢动力、应力和应变显著较低。同样，发现头胎胎儿产生的踢动力明显低于非头胎胎儿。有趣的是，与单胎相比，双胎未观察到显著差异。这项研究首次证明了胎儿活动生物力学与DDH风险之间的联系，可能为未来预防措施的制定和诊断的改进提供依据。我们的结果强调了超声筛查臀位和羊水过少的重要性，尤其是在妊娠后期，并表明通过外倒转术早期干预纠正臀位可降低髋关节发育不良的风险。
