A. Kurjak, G. Azumendi, N. Ve?ek, S. Kupe?ic, M. Solak, D. Varga, F. Chervenak
Fetal hand movements and facial expression in normal pregnancy studied by four-dimensional sonography
Aim: To evaluate the developmental pattern of fetal
hand movements and facial activity and expression during
the second and third trimester of pregnancy by four-dimensional
ultrasound (4D-US).
Subjects and methods: A total of 25 fetuses in uncomplicated
pregnancies were analyzed; 15 fetuses at 13 to
16 weeks and 10 fetuses at 30 to 33 weeks of gestation
were studied with abdominal 4D-US. After standard assessment
in two dimensional (2D) real-time B mode, a
4D mode was switched on. Further examination lasted a
maximum of 15 minutes.
Results: Isolated hand movement and subtypes of hand
movements were easily recognized by 4D-US. The subtypes
of hand to head movement are: hand to head, hand
to mouth, hand near mouth, hand to face, hand near face,
hand to eye and hand to ear. All subtypes of hand to
head movement can be seen from 13 weeks of gestation,
with fluctuating incidence.
Facial activities and different forms of expression are
easily recognized by 4D-US. Among these, two types can
be easily differentiated: smiling and scowling.
Conclusions: 4D-US is superior over real-time two-dimensional
ultrasound (2D-US) for qualitative, but inferior
for quantitative analysis of hand movements. Thus
4D-US makes it possible to determine exactly the direction
of the fetal hand, but the exact number of each type
of hand movements can still not be determined. 4D-US
is superior over two- and three-dimensional sonography
in the evaluation of complex facial activity and expression.
Among facial activities observed by 4D-US, simultaneous
eyelid and mouthing movements dominate between
30 and 33 weeks of gestation. Pure mouth
movements such as mouth opening, tongue expulsion,
yawning and pouting are present, but at a significantly
lower incidence. Facial expressions such as smiling and
scowling can be precisely observed using 4D-US.
Journal of Perinatal Medicine, Walter de Gruyter
Print ISSN: 1619-3997
Volume: 31, 11/2003
Pages: 496 - 508
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