Penilaian “neurobehaviour” pada

kasus pertumbuhan janin terhambat

Neuro behaviour – bidang kedokteran dan
psikologi.

Ultrasound – membantu mata dokter untuk

melihat kondisi janin didalam kandungan
Carmimichael’s quote

“ A study of adult behaviourwithout a

consideration of its origin before birth is as
incomplete as would be the at present
unthinkable study of adult anatomy without
reference to the embryology of the structures
considered”
Hepper 1995 and Shahidullah 1994

“The process of development begins in the prenatal

period with behaviors emerging and developing
continuously over gestation and childhood
Fetal neurobehaviour: Any observable action or
reaction (to an external stimulus) by the fetus
• Spontan
• Stimulated
• Spontaneous fetal behaviour – body movements,
fetal heart rate, coupling body movements and
FHR, breathing movements
• Stimulus induced behaviour – to examine two
fundamental issues – sensory and cognitive
development
• The usefulness of fetal behaviour in the
assessment of well-being
Behavior is a product of the functioning central
nervous system.
Study the behavior – it is possible to make inferences
about the functioning of the brain
The methodology used to obtain information relating
to fetal behaviour
• Maternal subjectivity
• Doppler ultrasound – CTG, Doppler velocimetry
• 2 D ultrasound
• 3 D Ultrasound
• 4 D Ultrasound,
Fetal cognition
Fetal responses to sound and vibration are being used
to examine fetal cognitive development
Complications associated with IUGR
• Oligohydramnios
• Non reassuring fetal heart rate
• Fetal death
4D Ultrasound provides
• Enable visualization of fetal movements
 4D ultrasound
• Practical means for assessment of
neurophysiologic development as well as
for detection of anatomical pathology

1. Kurjak A, Miskovic B, Andonotopo W, Stanojevic M, Azumendi G, Vrcic H. How useful is 3D

and 4D ultra- sound in perinatal medicine? J Peri- nat Med,2007;3:10-27.
2. Kurjak A, Vecek N, Hafner T, Bozek T, Funduk-Kurjak B, Ujevic B. Pre- nataldiagnosis: what
does four-di- mensional ultrasound add? J Perinat Med.2002;30:57–62.
IUGR Fetuses
• Hypothermia, hypoglycemia
• Increased risk of renal and cardiovascular in
later life
• Increased risk of childhood mortality
• Link to depression at women of under 26 of
age
• Increased risk of suicide in later lefi
• Suffer intelectual impairment in long term,
especially if neonatal management is less than
adequate
• 8 fold increased risk develop cerebral palsy
 Originate from Prenatal Causes

Back SA. Perinatal white matter inju- ry: the changing spectrum of pathol- ogyand
emerginginsights into patho- genetic mechanisms. Ment Retard Dev DisabilRes Rev.
2006;12:129-40.
Fetal behaviour can be defined as fetal activ-
ities observed or recorded with ultrasound
equipment”

Salihagic-Kadic A, Medic M, Kurjak A: Recent advances in neurophysiology. In: Kurjak A,

Azumendi G (eds): The Fetus in Three Dimensions: Imaging, Embryology, And
Fetoscopy. Informa Health Care, UK 2007.
Ultrasound evaluation of fetal blood
vessels using pulsed- wave (PW) Doppler
velocimetry is the cornerstone of
management and follow-up of FGR.
Biophysical Profile Score
Evidence from RCTs does not support the use of
BPS as a test of fetal well being in high-risk
pregnancies