Abnormal fetal movements, micrognathia and pulmonary hypoplasia: a case report. Abnormal fetal movements

A 27-year-old Japanese primigravida at 33 weeks of gestation was referred to our hospital. Ultrasonographic examination revealed clinical polyhydramnios. Micrognathia was evident on midsagittal and 3 D scan. The lung area was less than the mean -2.0 standard deviations for the gestational age. The infant had mandibular hypoplasia and glossoptosis. After emergency cesarean delivery for non-reasuring fetal status, required immediate tracheostomy and cardiopulmonary resuscitation with mechanical ventilatory support. However, the infant's cardiopulmonary condition did not improve and she died 21 hours after birth.The findings of our ultrasound exam are suggestive of brain dysfunction. The observation of fetal behavior appears to be effective for the prediction of prognosis of cases with micrognathia.Micrognathia is a facial malformation characterized by mandibular hypoplasia and a small, receding chin that fails to maintain the tongue in a forward position. Conditions associated with micrognathia include various abnormalities, and the prognosis of fetal micrognathia is poor, even in chromosomally normal fetuses [1,2]. When micrognathia is isolated, it is considered a component of Pierre-Robin syndrome (PRS) [1]. The underlying etiology of PRS has not yet been well established. Mandible growth results from oral motility, which begins during early fetal life [3].Previously, we reported a system of prenatal screening that we developed to identify fetuses with compromised central nervous system function by observing fetal behavior [4]. We report the case of a preterm infant with micrognathia and pulmonary hypoplasia who presented abnormal fetal movements.A 27-year-old Japanese primigravida at 33 weeks of gestation was referred to our hospital with polyhydramnios and threatened preterm labor. Ultrasonographic examination revealed clinical polyhydramnios (amniotic fluid index: 28 cm). Micrognathia was evident on midsagittal and 3 D scan (fig 1-a, b). The lung area of 8.9 cm2