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Assessment of Fetal Swallowing with Gray-Scale and Color Doppler Sonography

¹ Institute of Radiology, Second University of Naples, Naples, Italy.
² Department of Diagnostic Imaging, "A. Cardarelli" Hospital, Viale Cardarelli, 9, Naples 80131, Italy.
³ Dipartimento di Oncologia, Istituto di Ricerche Farmacologiche "Mario Negri," Milan, Italy.

OBJECTIVE. Our study was focused on the evaluation of fluid dynamics to assess the value of gray-scale and color Doppler sonography for evaluating the development of fetal swallow-related movements from early gestation until birth.

MATERIALS AND METHODS. We examined 56 fetuses from weeks 15–39 of gestation. Each fetus was examined throughout four distinct periods of gestation: weeks 15–18, 22–25, 30–34, and 37–39. During the examination, seven gray-scale sonography or color Doppler sonography patterns and their prevalence were considered.

RESULTS. Mandibular and/or labial movements (² = 56.4, p < 0.0001) and their rhythmic activity (² = 41.4, p < 0.0001) were seen on gray-scale sonography in an increasing percentage of fetuses as gestational age increased. Doppler findings showed an increase for nose–mouth flow signals (² = 57.6, p < 0.0001), larynx–esophagus flow signals (² = 13.2, p = 0.0003), and effective swallowing (² = 36.0, p < 0.0001) as gestational age increased.

CONCLUSION. There is a trend in the fetus toward development of increased coordinated movement and more functional nose–mouth flow with increasing gestational age: 32.1% of the 56 fetuses in our series achieved effective swallowing at 37–39 weeks, on the basis of gray-scale and Doppler evaluations. Knowledge of the physiologic mechanism involving swallowing development may allow identification of altered swallow-related movements in fetuses with malformations of the digestive tract or with neurologic disorders.

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