Differentiation between human fetal breathing patterns by investigation of breathing-related tracheal fluid flow velocity using Doppler sonography.

We report our results from the analysis of Doppler measurements of breathing-related fluid flow velocity waveforms in the trachea in human fetuses. Our aim was to determine whether, using the proposed method, reproducible patterns can be recognized over the latter half of gestation. Breathing-related tracheal fluid flow velocity of 47 normal fetuses at 20-39 weeks' gestation were analysed. Colour Doppler was used to document 'streaming' of fluid in the trachea, followed by spectral Doppler to record flow velocity waveforms. More than 40 (median 94; range 42-725) continuous breathing cycles (inspiration+expiration) were obtained in each case. Although breathing-related fetal tracheal fluid flow waveforms were found to be highly variable, we were able to distinguish by visual analysis between a regular and an irregular pattern. Among the regular patterns, we further differentiate between a regular symmetric (sinusoidal type) and a regular asymmetric (deep inspiration with expiratory flow retardation) pattern. The regular pattern occurred consistently in all age groups studied and there were no significant (p<0.05) differences in the occurrence rate of the regular symmetric and asymmetric pattern. The incidence of the regular pattern increased significantly (p<0.05) from 11.74+/-3.38% (mean +/- SEM) at 24-27 weeks to 20.72+/-1.75% at 28-31 weeks of gestation and remained constant thereafter. This study shows that the proposed method can provide detailed information on breathing-related tracheal fluid flow velocity as early as 20 weeks of gestation. The information that a regular symmetric pattern was observed throughout the second half of gestation is important. Hence, a higher standardization of on-going fetal breathing movements studies may be achieved by measuring breathing-related tracheal fluid flow velocity waveform parameters only during this pattern.