The relationship between fetal activity and behavioral states and fetal breathing movements in normal and growth-retarded fetuses.

The incidence of fetal breathing was studied during the course of behavioral state observations on 28 low-risk fetuses between 32 and 40 weeks' gestational age and on 12 growth-retarded fetuses between 36 and 40 weeks. Real-time ultrasound scanners were used to detect fetal eye, body, and breathing movements, and the fetal heart rate was recorded continuously. The mean duration of the observation sessions was 110 minutes. The mean incidence of fetal breathing was greater during periods of fetal activity (body and eye movements present, greater heart rate variability) than during quiescence (body and eye movements absent, narrowed heart rate variability) at all gestational ages studied in both low-risk and growth-retarded fetuses. During periods when one of the state variables (body movements, eye movements, heart rate pattern) was in its active condition while the other two were quiet, or the reverse, the incidence of fetal breathing was intermediate between those found when all three state variables were in agreement. After behavioral states had developed, at 38 and 40 weeks, the mean incidence of fetal breathing in the low-risk fetuses was greater during active states than during the quiet state. There was no apparent increase in the degree of linkage between fetal breathing and other expressions of fetal activity after the emergence of behavioral states.

Behavioural states in the fetuses of nulliparous women.

Behavioural state observations were carried out serially on the fetuses of 14 low risk nulliparae. They were observed serially at 2-weekly intervals between 32 weeks gestational age and delivery at term. Two real-time ultrasound B-scanners were used to visualize fetal body, eye and breathing movements. Fetal heart rate patterns were recorded simultaneously by means of a clinical fetal monitor. States appeared to be present transiently in three fetuses at 34 weeks. States were definitely present in five of 13 fetuses studied at 38 weeks and six of seven observed at 40 weeks. In comparison to the fetuses of low risk multiparae studied earlier, the fetuses in the present study showed a somewhat lower proportion of quiescence (coincidence 1F) and higher percentage of activity (coincidence 2F); however, most of these differences were not statistically significant. In the fetuses which showed states, the distribution and durations of the states at 38 and 40 weeks were not different from those found previously in the fetuses of multiparae. We conclude that the development of behavioural states is generally similar in the fetuses of low risk nulliparae and multiparae, but that states appear at a somewhat later gestational age in the fetuses of nulliparae.

Behavioural states in growth-retarded human fetuses.

Behavioural state observations were carried out on 12 fetuses which subsequently had birthweights below the 10th percentile. Their gestational ages at the time of study ranged from 32 to 40 weeks. Real-time ultrasound scanning was used to detect fetal body and eye movements, and the fetal heart rate was continuously recorded using a clinical fetal monitor. None of these fetuses was severely acidemic or depressed at birth. Findings in the growth-retarded fetuses were compared with those obtained in the fetuses of 14 low risk nulliparae and 14 low risk multiparae by means of the same techniques (van Vliet et al. (1985) Early Hum. Dev., 12, 121-135.; Nijhuis et al. (1982) Early Hum. Dev., 6, 177-195). The appearance of states seemed to be delayed in the growth-retarded fetuses. States were present in only three of eight growth-retarded fetuses studied at 40 weeks, whereas only one of 16 low risk fetuses did not show states at this age. Also at 40 weeks, the proportion of discordant association of the state variables was increased in the growth-retarded fetuses in comparison to the low risk group. There were no consistent differences between the two groups in the occurrence of defined combinations of parameters of the state variables at earlier ages. The growth-retarded fetuses showed differences in the quality and quantity of somatic motility in comparison to low risk fetuses of equivalent gestational age. These observations suggest that some aspects of central nervous system function are disturbed in growth-retarded fetuses, even in the absence of fetal distress.

The effect of maternal hyperoxia on breathing movements, body movements and rest-activity cycles of low-risk human fetuses.

The effects of maternal hyperoxia on fetal breathing and body movements, and on fetal activity state as reflected in the fetal heart rate pattern, were studied in 20 healthy gravida. Fetal breathing and trunk movements were observed by means of real-time ultrasound scanning, and the fetal heart rate was recorded continuously before, during and after 30 min of maternal oxygen inhalation by mask. Maternal transcutaneous oxygen tension (TcPO2) was measured in 9 subjects. The protocol was also carried out in ten of the gravidas with substitution of compressed air for oxygen. Maternal TcPO2 nearly doubled during oxygen breathing in the subjects in whom this was measured. There were no significant changes in the incidence of fetal breathing or trunk movements, or in the distribution of heart rate patterns, during maternal oxygen breathing. Also, no differences were observed in these variables between the oxygen and compressed-air experiments. We conclude that the normal level of fetal oxygenation does not limit fetal activity in uncomplicated pregnancies.

Malignant struma ovarii.

Malignant struma ovarii is a very rare tumor, belonging to the group of germ cell tumors. The diagnosis is difficult and there is no agreement in the literature concerning the necessary histologic features for malignancy. A case report is presented and the problems of diagnosing are discussed.

Congenital meningeal sarcoma--a case report.

A 30-year-old multigravida woman was admitted to the obstetrical unit in the third trimester of gestation, because of a large-for-date uterus. Repeated ultrasonic examinations over a 2-week period revealed an increase in biparietal diameter far too large to be normal. This progressive asymmetrical hydrocephalus was diagnosed as caused by an intracranial space-occupying lesion in the middle cranial fossa. Because of the only minimal thickness of the cerebral cortex prognosis was judged so poor, that labor was induced. A stillborn female infant was delivered vaginally after an ultrasonically guided transabdominal and later transcervical encephalocentesis. Autopsy revealed hydrocephalus and section through the fixed brain showed that the mentioned mass was an undifferentiated meningeal sarcoma that filled the left middle cranial fossa. Microscopically the sarcoma was invading the brain tissue. Definitions of the term "congenital brain-tumors" vary among authors. "Congenital" can be interpreted as "derived from embryonal tissue" or as "originating in utero". Congenital intracranial neoplasms are very rare. Antenatally intracranial tumors have been reviewed by Wells, Solitare and Farwell. Only a few cases of congenital brain tumors arising in the meninges have been reported in these reviews. The genesis of the tumor is explained as derived from multipotential cells. The undifferentiated type of a meningeal sarcoma has a poor prognosis. Most meningeal sarcoma present with progressive hydrocephalus.(ABSTRACT TRUNCATED AT 250 WORDS)