3D/4D HDlive rendering images seem to be more readily discernible than those obtained by conventional 3D/4D sonography. 3D/4D HDlive may be an important modality in future embryonic research, fetal neurobehavioral assessment, and the evaluation of fetal anomalies.

The results indicate that facial expressions can be used as an indicator of normal fetal neurologic development from the second to the third trimester. 4D ultrasound may be a valuable tool for assessing fetal neurobehavioral development during gestation.

Objective:  The purpose of our study was to evaluate the fetal behavioral pattern in the early second trimester of pregnancy by use of a specially developed abdominal real‐time three‐dimensional sonography. Methods:  Real‐time three‐dimensional sonographic examinations were performed on 11 normal pregnant women from 14 to 18 weeks of gestation. This imaging system provides continuous three‐dimensional sonographic images every 1–2 s. The fetal movement was monitored for 60 min in each patient, and head, mouth, arm, trunk, and leg movements were evaluated. All fetal behavioral patterns were observed during the period studied. Results:  Active phase (time with fetal movements) was 59.4%, and resting phase 40.6%. The most active fetal behavioral pattern was an arm movement, whereas the least was a mouth movement. Moreover, each fetal movement was synchronized and harmonized with other fetal movements. Conclusions:  Real‐time three‐dimensional sonography provides a novel means on the evaluation of fetal behavior in the early second trimester of pregnancy. These results suggest that real‐time three‐dimensional sonography become an important modality in future early fetal behavior research and in evaluation of fetal well‐being in the second trimester of pregnancy.

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.

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