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ENT of UATION MEMOR the HUMAN FETUS Cothelijne Van Heter

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ENT of UATION MEMOR the HUMAN FETUS Cothelijne Van Heter PDF hosted at the Radboud Repository of the Radboud University Nijmegen The following full text is a publisher's version. For additional information about this publication click this link. http://hdl.handle.net/2066/146798 Please be advised that this information was generated on 2021-09-24 and may be subject to change. ENT OF UATION MEMOR THE HUMAN FETUS Cothelijne van Heter • DEVELOPMENT OF HABITUATION AND MEMORY IN THE HUMAN FETUS Van Heteren, Cathelijne Francisca - Development of habituation and memory in the human fetus - 2001 Thesis University Nijmegen - with réf.- with summary m Dutch -136 p. ISBN: 90-9015000-5 Print: Grafisch Bedrijf Ponsen &i Looijen BV Wageningen Graphic Design Marie-Louise Dusée No part of this book may be reproduced in any form without permission of the author. This research project was financially supported by ZorgOnderzoek Nederland and the Hersenstichting Nederland. Publication of this thesis was financially supported by ATL Nederland BV, Ferring BV, GlaxoSmithKline, Hitachi Ultrasound BV, Medical Dynamics, Novo Nordisk Farma BV, Organon Nederland BV, Pie Medical Benelux BV, Sanofi-Synthélabo, Schering Nederland BV. DEVELOPMENT OF HABITUATION AND MEMORY IN THE HUMAN ?-f τ'••<, Een wetenschappelijke proeve op het gebied van de Medische Wetenschappen Proefschrift ter verkrijging van de graad van doctor aan de Katholieke Universiteit Nijmegen, volgens besluit van het College van Decanen in het openbaar te verdedigen op vrijdag 5 oktober 2001 des namiddags om 1.30 uur precies door Cathelijne Francisca van Heteren Geboren op 11 augustus 1971 te Arnhem Promotor: Prof dr J G Nijhuis Co-promotores: Dr Ρ F Boekkooi Dr HW Jongsma Manuscriptcommissie: Prof dr M van de Bor (voorzitter) Prof dr PG Hepper, FBPsS (The Queen's University of Belfast) Dr EJH Mulder (UMC Utrecht) d'n iene di rent veur zien leave d'n andere wandelt hiel rustig vuurbeej heej zuj d'r alles vur geave en heej zet ze moge ut hebbe van meej woar ge ok loept en wat ge ok bint niemand de zeat ow wat goed is of slecht niemand die wet wie verluust of wie wint ge komt op ut end beej ow zelf terecht Jack Poels Voo/· mijn ouders Voor Roel CONTENTS List of abbreviations 10 Chapter 1 General introduction and objectives 11 Fetal surveillance and neurological assessment 13 Fetal responses to vibroacoustic stimulation 17 Fetal habituation to repeated vibroacoustic stimulation 21 Objectives of this thesis 27 Chapter 2 Study design 29 Chapter 3 Fetal habituation to vibroacoustic stimulation m relation to fetal states and fetal heart rate parameters 35 Early Hum Dev 2007,67 735-45 Chapter 4 Fetal memory demonstrated by habituation testing in term fetuses 47 Lancet (research letter) 2000,356 7769-70 - Lancet (correspondence) 2001,357479 Chapter 5 Development of memory in the human fetus, demonstrated by habituation to vibroacoustic stimulation 55 Submitted Chapter 6 Fetal habituation to vibroacoustic stimulation in uncomplicated postterm pregnancies 67 Eur J Ob Cyn Reprod Biol 2001,97 '7^ 82 Chapter 7 Fetal habituation to vibroacoustic stimulation in pregnancies complicated by intrauterine growth retardation 77 Chapter 8a Responses to repeated vibroacoustic stimulation m a fetus with trisomy 18, a case-study 87 Eur J Obstet Cyn Reprod Biol 2001,96 725-5 Chapter 8b Responses to vibroacoustic stimulation in a fetus with an encephalocele compared to responses of normal fetuses 93 J Pennat Med 2000,28 306-8 Chapter 8c Responses to vibroacoustic stimulation in a fetus with a hydrocephalus, a case study 99 Submitted Chapter 9 Summary and discussion 107 Samenvatting 113 References 117 Bibliography 129 Dankwoord 131 LIST OF ABBREVIATIONS bpm beat(s) per minute cm centi meter(s) FHR fetal heart rate FHRP fetal heart rate patterns g gram GA gestational age IUCR intrauterine growth retarded / retardation LTV long term fetal heart rate variation m meter ms millisecond(s) η number pH degree of acidity s second(s) STV short term fetal heart rate variation VAS vibroacoustic stimulation / stimulus The major goal of fetal surveillance is the reduction of fetal morbidity and mortality in fetuses with an increased risk of these complications. To this end, the accurate assessment of fetal wellbemg and early detection of disabilities (neuro- developmental disorders) are essential. Neurological morbidity includes subtle to severe functional disturbances, such as motor delay, speech delay, deafness, blind­ ness, cerebral palsy, and mental retardation. A study on the birth prevalence of moderate or severe newborn encephalopathy in a normal population in Western Australian showed that this prevalence is 3.8 per 1000 term live births and the neonatal case fatality is 9.1% '. Despite the "intensive obstetrics" of the past 30 years, with increasing attention being given to prenatal care, reduction of birth trauma, and the greater use of cesarean section for high-risk deliveries, the frequency of neurodevelopmental dis­ orders remains unchanged 2'7 Genetic, congenital and environmental factors can all adversely affect the developing individual any time from conception to birth. Independent risk factors before conception and in the antepartum period for new­ born encephalopathy include socioeconomic status, family history of seizures or other neurological disease, conception after infertility treatment, maternal thyroid disease, severe pre-eclampsia, bleeding m pregnancy, viral illness, having an abnor­ mal placenta, intrauterine growth retardation (IUGR), and postmaturity '. However, in the majority of children with cerebral palsy, mental retardation, and other chronic neurodevelopmental disorders, no specific cause can be identified β But prenatal factors do seem to play an important role in the development of subsequent neu­ rological disability and handicap'69'0 Factors leading to encephalopathy may occur in the antepartum period, imme­ diately preceding the onset of (premature) labour, in the intrapartum period, or in the neonatal period For many years it was accepted that fetal asphyxia during labour was the major cause of both neonatal encephalopathy and cerebral palsy. However, the evidence for this is surprisingly thin 6. Researchers are reassessing the factors associated with neonatal encephalopathy and cerebral palsy, with increasing emphasis on events before the perinatal period '6". Research on the causation of neurodevelopmental disorders needs to focus more on prenatal events 12 because most bram injury would seem to occur before birth. Much more under­ standing of fetal brain development and factors affecting it is therefore needed to detect neurological abnormalities in the fetus and even more importantly, to even­ tually determine the cause of such defects to facilitate the prevention of neuro­ logical morbidity. While tests of the fetal genetic / chromosomal condition via the analysis of fetal cells, structure via ultrasound examination, and autonomic function via cardiotocography all contribute to the determination of fetal health, significant advances would be made in identifying and finally preventing neurodevelopmental disorders if it were possible to examine the fetal central nervous system (CNS) function. However, there is currently no precise method for the antenatal assess­ ment of fetal CNS functioning m obstetrical practice. FETAL SURVEILLANCE AND NEUROLOGICAL ASSESSMENT Until the 1970's, neurological assessment was only possible after the infant had been born. Prenatally acquired functional impairments of the CNS could not be detected earlier than some time after birth. Only indirect assessment of the fetal condition was possible, e.g. by the mother counting fetal movements or by moni­ toring the fetal heart rate (FHR). These measures are not sensitive enough for a neurological assessment of the fetus A breakthrough was achieved in the 1970's with the introduction of real-time ultrasound, and since then it has been possible to observe the fetus. The introduction of real-time ultrasound made it possible to study the fetus A variety of fetal movements ranging from general body movements to detailed movements of the face, fingers and toes can be observed. Physiological functions such as FHR, stomach and bladder emptying can also be perceived. Studying fetal behaviour is one of the many ways to identify fetal disorders Just as behavioural studies of the infant or adult can be used to assess the individual's present condition and predict later behaviour and functioning, so can the behaviour exhibited by the individual prior to birth also be used to assess its present functioning. Fetal behaviour represents the functioning and integrity of the CNS, therefore assessment of fetal behaviour provides a means of assessing fetal CNS functioning. At present a vast array of methods is used to assess fetal CNS, but none of them is entirely satisfactory Antenatal cardiotocography (CTG), the non-stress test, has become widely accepted as the primary method of antenatal fetal monitoring " The test is conducted in pregnancies where fetal wellbemg is questioned, e g postterm pregnancy, reduced fetal movements, hypertensive disease, growth retardation and bleeding in pregnancy '3 CTC records the FHR (reactivity, variation, accelerations, decelerations etc.). Four randomised trials for the purpose of fetal assessment that compared 13 antenatal cardiotocography with a control group were conducted in the early 1980's when the antenatal CTG was introduced ""7. These trials concluded that the antenatal CTG has no significant effect on perinatal outcome or on interventions
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