Fetal brain monitoring: Future applications

Abstract

Summary Future application of fetal brain monitoring is explored by selecting and analysing articles for information on types of brain damage that can be monitored, where in the brain this can be done, how long after the risk exposure, and with what method of investigation.A limited number ofdmainlydcase histories reported that early (cell death and oedema) and late (gliosis) effects of brain damage can be demonstrated before birth with multiplanar ultrasound and magnetic resonance imaging, and that hypoxic ischaemic injury or infection can induce local or widespread brain injury, occurring as transient or longer-lasting changes in age-related predilection areas for which normal features are known.The antenatal role of risk factors inducing abnormal brain development can be studied longitudinally with ultrasound and magnetic resonance imaging. A multidisciplinary approach will facilitate the introduction of various techniques with adequate know-how of underlying processes, to evaluate the predictive value on neurological outcome and prevent premature introduction into clinical application. ª

Additional value of advanced neurosonography and magnetic resonance imaging in fetuses at risk for brain damage

“…Other risk factors, such as chronic hypoxia/ischemia in growth-restricted fetuses and congenital infection, cause damage gradually over time, if any damage does occur. The earliest signs may appear after about 1 week, including increased echogenicity/SI in the injured area, followed by cysts, replacement of damaged areas by fibrillary processes, thinning of brain areas and deposition of minerals 1 . Implementation of multiplanar neurosonography for fetal central nervous system assessment has been advocated by experts in the field of ultrasound 7 since as early as 1996.…”

“…The increasing quality of ultrasound and magnetic resonance imaging (MRI) of the fetal brain has enabled the assessment of subtle changes, for example, in the white matter and peri-and intraventricular areas, which are prone to hypoxia/ischemia or infection [1][2][3][4][5][6] .…”

“…Despite an abundance of literature on neurosonography and brain MRI, there is no consensus on which is the preferred neuroimaging technique in detecting and monitoring acquired brain anomalies 1,[12][13][14] . Until now, various disciplines, obstetricians, pediatricians and radiologists have used their own disciplinary or local guidelines.…”