We are failing to identify disorders of fetal movement – why?

Filges, Isabel; Hall, Judith G.

doi:10.1002/pd.3944

Cited by 10 publications

(11 citation statements)

References 16 publications

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“…However, there have been no detailed descriptions of foetal movement patterns in multiple foetuses with arthrogryposis over several gestational time-points, and therefore, the causal relationship between movements (or change in, or lack thereof) and contractures is unclear. As highlighted by Filges and Hall (2012), most cases of arthrogryposis are not diagnosed prenatally, due to the fact that quantification of foetal movements do not generally form part of standard assessments. Introducing quantification of foetal movements as part of a foetal assessment would likely greatly increase the rate of prenatal diagnosis of arthrogryposis, but will also provide more substantial evidence of the link between movements and contractures.…”

Section: Musculoskeletal Conditionsmentioning

confidence: 99%

Biomechanics of foetal movement

Nowlan¹

2015

eCM

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Foetal movements commence at seven weeks of gestation, with the foetal movement repertoire including twitches, whole body movements, stretches, isolated limb movements, breathing movements, head and neck movements, jaw movements (including yawning, sucking and swallowing) and hiccups by ten weeks of gestational age. There are two key biomechanical aspects to gross foetal movements; the first being that the foetus moves in a dynamically changing constrained physical environment in which the freedom to move becomes increasingly restricted with increasing foetal size and decreasing amniotic fluid. Therefore, the mechanical environment experienced by the foetus affects its ability to move freely. Secondly, the mechanical forces induced by foetal movements are crucial for normal skeletal development, as evidenced by a number of conditions and syndromes for which reduced or abnormal foetal movements are implicated, such as developmental dysplasia of the hip, arthrogryposis and foetal akinesia deformation sequence. This review examines both the biomechanical effects of the physical environment on foetal movements through discussion of intrauterine factors, such as space, foetal positioning and volume of amniotic fluid, and the biomechanical role of gross foetal movements in human skeletal development through investigation of the effects of abnormal movement on the bones and joints. This review also highlights computational simulations of foetal movements that attempt to determine the mechanical forces acting on the foetus as it moves. Finally, avenues for future research into foetal movement biomechanics are highlighted, which have potential impact for a diverse range of fields including foetal medicine, musculoskeletal disorders and tissue engineering.Keywords: Foetal movement, fetal movement, bone development, joint development, developmental dysplasia of the hip, arthrogryposis, biomechanical models, computational simulation, mechanical properties of foetal tissues, mechanical properties of fetal tissues.

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Section: Musculoskeletal Conditionsmentioning

confidence: 99%

Biomechanics of foetal movement

Nowlan¹

2015

eCM

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“…AMC is usually diagnosed at birth, and only one in four cases may be diagnosed prenatally 9. When prenatal diagnosis is possible, it usually occurs in late second or early third trimesters 10.…”

Section: Discussionmentioning

confidence: 99%

Successful pregnancy in a woman with arthrogryposis multiplex congenita

2013

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Arthrogryposis multiplex congenita refers to a clinical condition or syndrome characterised by multiple congenital contractures that affect two or more different areas of the body. Of the cases reported so far, an important percentage had to be terminated before pregnancy term, predominantly by caesarean section. We describe a 36 year-old woman who wanted to conceive. A multidisciplinary approach was set from the preconceptional period and special attention was given to respiratory function, potential anaesthetic difficulties and thromboembolic risks. She delivered by caesarean section at 38 weeks. This case emphasises the possibility of achieving a term delivery in these patients and points out the importance of a multidisciplinary team, specially of obstetricians and anaesthesiologists.

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“…Filges and Hall () studied the records on 107 patients born with amyoplasia after 1990. The failure to monitor fetal movement and identify contractures has resulted in more than 75% of fetuses remaining undetected until birth (Filges & Hall, , ; Hall, ). Failure of early detection precludes further etiologic and diagnostic workup and deprives families of making informed pregnancy choices.…”

Section: The Role Of Prenatal Ultrasoundmentioning

confidence: 99%

“…The limb buds can be seen on sonogram at as early as 8 weeks of gestation, and limb joints and digits are visible by 11 ± 12 weeks (Dimitraki et al, ). Current ultrasound practice identifies only approximately 25% of individuals with arthrogryposis before 24 weeks of pregnancy in a general obstetrics care population (Filges & Hall, , ; Hall, ). There are no specific guidelines as to the ultrasound screening of limb development, contractures, and fetal movement.…”

Section: Introductionmentioning

confidence: 99%

Fetal arthrogryposis: Challenges and perspectives for prenatal detection and management

Filges

Tercanli

Hall

2019

American J of Med Genetics Pt C

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Antenatal identification of fetuses with multiple congenital contractures or arthrogryposis multiplex congenita (AMC) may be challenging. The first clinical sign is often reduced fetal movement and/or contractures, as seen on prenatal ultrasounds. This can be apparent at any point, from early to late pregnancy, may range from mild to severe involvement, with or without associated other structural anomalies. Possible etiologies and their prognosis need to be interpreted with respect to developmental timing. The etiology of AMC is highly heterogeneous and making the specific diagnosis will guide prognosis, counseling and prenatal and perinatal management. Current ultrasound practice identifies only approximately 25% of individuals with arthrogryposis prenatally before 24 weeks of pregnancy in a general obstetrics care population. There are currently no studies and guidelines that address the question of when and how to assess for fetal contractures and movements during pregnancy. The failure to identify fetuses with arthrogryposis before 24 weeks of pregnancy means that physicians and families are denied reproductive options and interventions that may improve outcome. We review current practice and recommend adjusting the current prenatal imaging and genetic diagnostic strategies to achieve early prenatal detection and etiologic diagnosis. We suggest exploring options for in utero therapy to increase fetal movement for ongoing pregnancies.

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We are failing to identify disorders of fetal movement – why?

Cited by 10 publications

References 16 publications

Biomechanics of foetal movement

Biomechanics of foetal movement

Successful pregnancy in a woman with arthrogryposis multiplex congenita

Fetal arthrogryposis: Challenges and perspectives for prenatal detection and management

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