EDITORIAL Fetal Neuropathology and Abnormal Motor Assessment—Fetal Akinesia Deformation Sequence: KANET is of Additional Value for the In Utero Diagnosis Hermann U Honemeyer 1 , Asim Kurjak 2 A BSTRACT The fetal activity has a fundamental role in forming the fetal gestalt. Fetal movements produce biomechanical stress, with distinct biochemical efects determining the morphogenesis of the musculoskeletal apparatus. As a result of normal maturation of the fetal brainstem, and shaped by general movements (GMs) and increasing variability of highly diferentiated isolated movements, the typical human fetal gestalt evolves. KANET scoring system allows quantitative and qualitative determination and analysis of fetal movements and gestalt during the second and the third trimesters. The diagnostic efciency of KANET in detecting abnormal fetal behavior and neuromorbidity is demonstrated with two cases of fetal akinesia deformation sequence (FADS). Keywords: Fetal akinesia deformation sequence, Fetal behavior, Fetal gestalt, Fetal neurology, Kurjak’s antenatal neurodevelopment test. Donald School Journal of Ultrasound in Obstetrics and Gynecology (2019): 10.5005/jp-journals-10009-1601 I NTRODUCTION The research of fetal behavior has been stimulated and advanced by 3D and 4D ultrasound technology. With ever-improving image quality and frame rates, stunning insights into the fetal world provide an abundance of scientifc material and have become a fascination for parents. While many researchers recognized the potential of 3D and 4D ultrasound for studying fetal activity, it is the merit of Asim Kurjak and his group to have observed and categorized normal fetal movements in longitudinal studies during pregnancy and, thus, given us a concept of normal fetal behavior (Kurjak et al.). 1 “Kurjak’s Antenatal Neurodevelopment Test” (KANET), as the result of these studies, represents the frst standardized easy-to-learn/easy-to-use sonographic scoring system which allows to measure the degree of deviation from normal fetal behavior in utero. The relevance of this scoring system becomes more than obvious in the clinical scenario of FADS, where the examiner is “struck” by total immobility of a fetus which may otherwise exhibit only minor structural or postural abnormalities. Here, the hint at a fatal neuropathology of the fetus comes essentially from the abnormal result of the fetal motor assessment. In this case study, KANET was applied in two cases of polyhydramnios with absent fetal movements/abnormal gestalt, and led to the diagnosis of FADS. Furthermore, this case study intends to highlight the key role of abnormal or absent fetal movement in the etiology of fetal morphological deformation. C ASE D ESCRIPTION Case 1 A second gravida para 1, 40 years old, with spontaneous vaginal delivery at the term of her frst child, had conceived spontaneously. She was referred to us at 30 + 2 weeks for fetal biometry and Doppler. She had felt the frst “quickening” at 18 weeks, but fetal movements had stopped abruptly at 26 weeks. Fetal movements had started 3 weeks earlier than in her frst pregnancy, a rather common experience in multiparity; however, she emphasized that they were more frequent and vigorous in this second pregnancy. Her previous medical, obstetric, and family history was unremarkable. In this second pregnancy, early pregnancy scans, frst trimester nuchal translucency screening, and a detailed second trimester fetal anatomy scan had all been normal. On noticing decreased fetal movements at 26 weeks, she went to a hospital emergency where she was reassured. Our sonographic fndings at gestational age 30 + 2 weeks: normal fetal anatomy. Biometry equivalent to 28 + 1 weeks. Abdominal circumference (AC) minus 2.4 SD suggestive of intra- uterine growth restriction (IUGR). Except for a cerebellum diameter of minus 2.2 SD, neurosonography was normal. Normal middle cerebral artery (MCA), umbilical artery (Umb.A), and uterine artery (UA) Doppler waveforms and resistance indices. Mild polyhydramnios. Abnormal biophysical profle due to the absence of fetal movements and breathing. Fetal “Gestalt” and Motor Assessment with 3D/4D Ultrasound Using KANET The fetus was in a breech position with extended legs. The tongue protruded from a slightly gaping mouth. The fetal profle 1 Department of Obstetrics and Gynecology/Fetal Medicine, Alzahra Hospital and NMC Healthcare, Sharjah, UAE 2 Department of Obstetrics and Gynecology, Medical School University of Zagreb, Zagreb, Croatia; University Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina Corresponding Author: Hermann U Honemeyer, Department of Obstetrics and Gynecology/Fetal Medicine, Alzahra Hospital and NMC Healthcare, Sharjah, UAE, e-mail: dr.ulrich.ho@hotmail.com How to cite this article: Honemeyer HU, Kurjak A. Fetal Neuropathology and Abnormal Motor Assessment—Fetal Akinesia Deformation Sequence: KANET is of Additional Value for the In Utero Diagnosis. Donald School J Ultrasound Obstet Gynecol 2019;13(3):88–93. 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