What is future of perinatal imaging?

Understanding the structure and function of the fetal nervous system has been the dream of physicians for centuries. The pioneering efforts of Ian Donald in obstetric ultrasound in the latter part of the twentieth century have permitted this dream to become a reality.
The initial contribution of obstetric ultrasound focused on the normal and abnormal structure. As first neuro-sonographic diagnose, anencephaly was described, followed later by increasingly subtle central nervous system abnormalities such as agenesis of the corpus callosum. Now, 4D sonography in the functional evaluation of the fetal brain has become the challenge for investigators in obstetric ultrasound. There are many functional neurological abnormalities, with cerebral palsy (CP) as one of the most important, whose causes are still poorly understood. This etiological uncertainty makes CP a rewarding medico-legal field. Attorneys throughout the world want to relate neurological abnormalities exclusively to intrapartum events associated with suspected hypoxemia, such as usage of oxytocin, forceps or vacuum delivery, and failure to perform a timely Cesarean delivery.
While during the last two decades obstetricians have become a risk group in regards to medico-legal complications, there have been substantial advances in understanding the etiology of cerebral palsy: only 10% of later diagnosed CP are caused by intrapartum asphyxia. But many questions still remain open. The final goal of prevention may be more achievable after scientific comprehension of many collaborative factors involved in the origination of CP, this still mysterious entity. The new field of fetal neurology with the latest diagnostic tool KANET offers a professional challenge. With 4D sonography it is now possible to define reproducible parameters for the assessment of normal neurobehavioral development. There is urgent need for further multicentric studies until a sufficient degree of normative data is available and the predictive validity of specific aspects of fetal neurobehavior to child developmental outcome is better established. The role of obstetrician in the antenatal detection of CP is new exciting challenge.

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