Maternal perception of fetal movements: A qualitative description

<p>Background: Maternal perception of decreased fetal movements is a specific indicator of fetal compromise, notably in the context of poor fetal growth. There is currently no agreed numerical definition of decreased fetal movements, with subjective perception of a decrease on the part of the mother being the most significant definition clinically. Both qualitative and quantitative aspects of fetal activity may be important in identifying the compromised fetus.Yet, how pregnant women perceive and describe fetal activity is under-investigated by qualitative means. The aim of this study was to explore normal fetal activity, through first-hand descriptive accounts by pregnant women. Methods: Using qualitative descriptive methodology, interviews were conducted with 19 low-risk women experiencing their first pregnancy, at two timepoints in their third trimester. Interview transcripts were later analysed using qualitative content analysis and patterns of fetal activity identified were then considered along-side the characteristics of the women and their birth outcomes. Results: Fetal activity as described by pregnant women demonstrated a sustained increase in strength, frequency and variation from quickening until 28-32 weeks. Strength of movements continued to increase at term, but variation in movement types reduced. Kicking and jolting movements decreased at term with pushing or stretching movements dominating. In this study increased strength and frequency of movements at term as determined qualitatively by the mother was associated with higher mean customised birthweight of newborns, whilst decreased frequency was in all cases associated with either maternal obesity, customised birthweight under the 20th centile or operative delivery for non-reassuring fetal status. A novel finding of a complex pattern of fetal movements in relation to mealtimes is reported here. More than a third of participants (37%) described marked increases in fetal movements in response to hunger, in many cases subsiding postprandially. The women who described this pattern in response to hunger and eating, subsequently gave birth to infants significantly smaller (mean difference 364gm) than those who did not describe a fetal response to hunger. Patterns of fetal movements were reported to be influenced by time of day, maternal position and activity, with an inverse relationship between maternal activity and fetal activity described by all participants. Conclusions: Maternal descriptions of fetal movements with advancing gestation and in relation to time of day are consistent with fetal activity as described in ultrasound studies, lending reliability to the maternal account. Maternal perception of fetal movements in response to environmental stimuli such as maternal meals and maternal position-changes may constitute a maternal-fetal communication in the interests of maintaining the pregnancy. Pregnant women are reassured by fetal movements occurring at a usual time or situation, suggesting that maternal monitoring of fetal movements is a dynamic process taking into account a broad range of fetal functions.</p>

Maternal perception of fetal movements: A qualitative description

<p>Background: Maternal perception of decreased fetal movements is a specific indicator of fetal compromise, notably in the context of poor fetal growth. There is currently no agreed numerical definition of decreased fetal movements, with subjective perception of a decrease on the part of the mother being the most significant definition clinically. Both qualitative and quantitative aspects of fetal activity may be important in identifying the compromised fetus.Yet, how pregnant women perceive and describe fetal activity is under-investigated by qualitative means. The aim of this study was to explore normal fetal activity, through first-hand descriptive accounts by pregnant women. Methods: Using qualitative descriptive methodology, interviews were conducted with 19 low-risk women experiencing their first pregnancy, at two timepoints in their third trimester. Interview transcripts were later analysed using qualitative content analysis and patterns of fetal activity identified were then considered along-side the characteristics of the women and their birth outcomes. Results: Fetal activity as described by pregnant women demonstrated a sustained increase in strength, frequency and variation from quickening until 28-32 weeks. Strength of movements continued to increase at term, but variation in movement types reduced. Kicking and jolting movements decreased at term with pushing or stretching movements dominating. In this study increased strength and frequency of movements at term as determined qualitatively by the mother was associated with higher mean customised birthweight of newborns, whilst decreased frequency was in all cases associated with either maternal obesity, customised birthweight under the 20th centile or operative delivery for non-reassuring fetal status. A novel finding of a complex pattern of fetal movements in relation to mealtimes is reported here. More than a third of participants (37%) described marked increases in fetal movements in response to hunger, in many cases subsiding postprandially. The women who described this pattern in response to hunger and eating, subsequently gave birth to infants significantly smaller (mean difference 364gm) than those who did not describe a fetal response to hunger. Patterns of fetal movements were reported to be influenced by time of day, maternal position and activity, with an inverse relationship between maternal activity and fetal activity described by all participants. Conclusions: Maternal descriptions of fetal movements with advancing gestation and in relation to time of day are consistent with fetal activity as described in ultrasound studies, lending reliability to the maternal account. Maternal perception of fetal movements in response to environmental stimuli such as maternal meals and maternal position-changes may constitute a maternal-fetal communication in the interests of maintaining the pregnancy. Pregnant women are reassured by fetal movements occurring at a usual time or situation, suggesting that maternal monitoring of fetal movements is a dynamic process taking into account a broad range of fetal functions.</p>

Cesarean scar pregnancy treatment: a case series

Background Cesarean scar pregnancy is a complicated and potentially life-threatening type of ectopic pregnancy. This study reports two women with cesarean scar pregnancy who were successfully treated with systemic methotrexate administration, and two other women who needed local re-administration of methotrexate after systemic injection. Case presentation Four Iranian pregnant women aged 29–34 years who were between 5 to 7 gestational weeks with cesarean scar pregnancy diagnosis are described. After a single dose of systemic methotrexate injection, the level of serum beta-human chorionic gonadotropin decreased in two of the women, while fetal activity was observed in the other two women. In the latter patients, methotrexate was injected under transvaginal ultrasound guidance into the gestational sac. As a result, the serum beta-human chorionic gonadotropin level first increased and then decreased in these patients. During the follow-up period, all the patients were stable and no complications were observed. Serum beta-human chorionic gonadotropin levels reached the non-pregnancy range from 4 to 9 weeks after treatment. Conclusion When diagnosed at early gestation, cesarean scar pregnancy can be treated successfully with methotrexate administration alone. The clinicians should be aware that the beta-human chorionic gonadotropin level may initially increase after methotrexate injection in some patients. However, the final outcome will be promising if the patients remain stable.

Whence CRIPTO: The Reemergence of an Oncofetal Factor in ‘Wounds’ That Fail to Heal

There exists a set of factors termed oncofetal proteins that play key roles in ontogeny before they decline or disappear as the organism’s tissues achieve homeostasis, only to then re-emerge in cancer. Although the unique therapeutic potential presented by such factors has been recognized for more than a century, their clinical utility has yet to be fully realized1. This review highlights the small signaling protein CRIPTO encoded by the tumor derived growth factor 1 (TDGF1/Tdgf1) gene, an oft cited oncofetal protein whose presence in the cancer literature as a tumor promoter, diagnostic marker and viable therapeutic target continues to grow. We touch lightly on features well established and well-reviewed since its discovery more than 30 years ago, including CRIPTO’s early developmental roles and modulation of SMAD2/3 activation by a selected set of transforming growth factor β (TGF-β) family ligands. We predominantly focus instead on more recent and less well understood additions to the CRIPTO signaling repertoire, on its potential upstream regulators and on new conceptual ground for understanding its mode of action in the multicellular and often stressful contexts of neoplastic transformation and progression. We ask whence it re-emerges in cancer and where it ‘hides’ between the time of its fetal activity and its oncogenic reemergence. In this regard, we examine CRIPTO’s restriction to rare cells in the adult, its potential for paracrine crosstalk, and its emerging role in inflammation and tissue regeneration—roles it may reprise in tumorigenesis, acting on subsets of tumor cells to foster cancer initiation and progression. We also consider critical gaps in knowledge and resources that stand between the recent, exciting momentum in the CRIPTO field and highly actionable CRIPTO manipulation for cancer therapy and beyond.

Evolving pattern of fetal movements throughout a healthy pregnancy

A 31-year-old woman with a history of stillbirth due to placental abruption at 29 weeks’ gestation and one first trimester miscarriage documented a continuous record of her perceived fetal movements from 28 to 38 weeks’ gestation. Repeated ultrasound examinations confirmed a viable pregnancy, with normal growth, liquor volume and Doppler profile. She delivered a healthy male infant at 38 weeks and 3 days’ gestation. The data collected give a detailed record of fetal activity in a healthy pregnancy. Perceived fetal activity increased as pregnancy progressed and was greatest in the evenings. We also found that clusters of movements, which have previously been reported as protective against stillbirth, were felt earlier on in pregnancy.

Joint development recovery on resumption of embryonic movement following paralysis

Fetal activity in utero is a normal part of pregnancy and reduced or absent movement can lead to long-term skeletal defects such as Fetal Akinesia Deformation Sequence (FADS), joint dysplasia and arthrogryposis. A variety of animal models with decreased or absent embryonic movements show a consistent set of developmental defects providing insight into the aetiology of congenital skeletal abnormalities. At developing joints defects include reduced joint interzones with frequent fusion of cartilaginous skeletal rudiments across the joint. At the spine defects include shortening and a spectrum of curvature deformations. An important question, with relevance to possible therapeutic interventions for human conditions, is the capacity for recovery with resumption of movement following short term immobilisation. Here we use the well-established chick model to compare the effects of sustained immobilisation from embryonic day (E) 4-10 to two different recovery scenarios: (i) natural recovery from E6 until E10 and (ii) the addition of hyperactive movement stimulation during the recovery period. We demonstrate partial recovery of movement and partial recovery of joint development under both recovery conditions, but no improvement in spine defects. The joints examined (elbow, hip and knee) showed better recovery in hindlimb than forelimb, with hyperactive mobility leading to greater recovery in the knee and hip. The hip joint showed the best recovery with improved rudiment separation, tissue organisation and commencement of cavitation. This work demonstrates that movement post paralysis can partially-recover specific aspects of joint development which could inform therapeutic approaches to ameliorate the effects of human fetal immobility.

Joint development recovery on resumption of embryonic movement following paralysis

Fetal activity in utero is a normal part of pregnancy and reduced or absent movement can lead to long-term skeletal defects such as Fetal Akinesia Deformation Sequence (FADS), joint dysplasia and arthrogryposis. A variety of animal models with decreased or absent embryonic movements show a consistent set of developmental defects providing insight into the aetiology of congenital skeletal abnormalities. At developing joints defects include reduced joint interzones with frequent fusion of cartilaginous skeletal rudiments across the joint. At the spine defects include shortening and a spectrum of curvature deformations. An important question, with relevance to possible therapeutic interventions for human conditions, is the capacity for recovery with resumption of movement following short term immobilisation. Here we use the well-established chick model to compare the effects of sustained immobilisation from embryonic day (E) 4-10 to two different recovery scenarios: (i) natural recovery from E6 until E10 and (ii) the addition of hyperactive movement stimulation during the recovery period. We demonstrate partial recovery of movement and partial recovery of joint development under both recovery conditions, but no improvement in spine defects. The joints examined (elbow, hip and knee) showed better recovery in hindlimb than forelimb, with hyperactive mobility leading to greater recovery in the knee and hip. The hip joint showed the best recovery with improved rudiment separation, tissue organisation and commencement of cavitation. This work demonstrates that movement post paralysis can partially-recover specific aspects of joint development which could inform therapeutic approaches to ameliorate the effects of human fetal immobility.

Novel Phonography-Based Measurement for Fetal Breathing Movement in the Third Trimester

The detailed assessment of fetal breathing movement (FBM) monitoring can be a pre-indicator of many critical cases in the third trimester of pregnancy. Standard 3D ultrasound monitoring is time-consuming for FBM detection. Therefore, this type of measurement is not common. The main goal of this research is to provide a comprehensive image about FBMs, which can also have potential for application in telemedicine. Fifty pregnancies were examined by phonography, and nearly 9000 FBMs were identified. In the case of male and female fetuses, 4740 and 3100 FBM episodes were detected, respectively. The measurements proved that FBMs are well detectable in the 20–30 Hz frequency band. For these episodes, an average duration of 1.008 ± 0.13 s (p < 0.03) was measured in the third trimester. The recorded material lasted for 16 h altogether. Based on these measurements, an accurate assessment of FBMs could be performed. The epochs can be divided into smaller-episode groups separated by shorter breaks. During the pregnancy, the rate of these breaks continuously decreases, and episode groups become more contiguous. However, there are significant differences between male and female fetuses. The proportion of the episodes which were classified into minimally 10-member episode groups was 19.7% for males and only 12.1% for females, even at the end of the third trimester. In terms of FBM detection, phonography offers a novel opportunity for long-term monitoring. Combined with cardiac diagnostic methods, it can be used for fetal activity assessment in the third trimester and make measurement appreciably easier than before.