Early Studies:

• Initial focus on fetal motor activity, based on observations of aborted human fetuses.
• 1837: Erbkam publishes the first descriptions of fetal movements from observations of spontaneous miscarriages.
• 1930s: Pittsburgh anatomist Davenport Hooker studies and films the activity of human fetuses from clinically indicated surgical abortions.

Major Forces Driving Development:

• Fetal Imaging Advances:
  • 1970s: Introduction of 2D-ultrasound enables real-time observation of fetal morphology.
  • Heinz Prechtl and European investigators study in utero fetal behavior and create detailed developmental descriptions of fetal movements.
  • Observations used to assess the integrity of the developing nervous system.
• Preterm Newborn Neurology:
  • Advances over the past 40 years in understanding the neurology of preterm newborn infants ('ex utero fetus').
• Recognition of Fetal Origins of Chronic Diseases:
  • Major chronic diseases of childhood and adulthood, including neurological and psychiatric conditions, have origins in fetal life.
  • Conditions such as attention deficit disorder, autism, and schizophrenia linked to fetal development.

Role of Fetal Neurology:

• Focus on intrauterine support of fetal brain development to prevent catastrophic perinatal brain injury.
• Advances in fetal imaging improve understanding and diagnostic capabilities.
  • Increased structural resolution of fetal MRI detects smaller anatomic changes, requiring detailed knowledge of normal fetal brain development.
• Aetiological diagnosis often pursued with limited additional neurodiagnostic tools.
• Important considerations include neurodevelopmental prognosis, likelihood of recurrence, and how the fetal brain will tolerate labor and delivery hazards.
• Additional diagnostic testing for genetic or environmental causes may be needed based on imaged phenotype.

Challenges for Fetal Neurologists:

• Pressure to gather all available diagnostic information timely, especially when termination of pregnancy is an option.
• Frequent need to formulate opinions with limited data and without a conventional physical examination of the fetus.
• Providing brain-oriented recommendations for labor, delivery, and the transitional period to minimize secondary brain injury risks.

Expertise Required:

• In-depth understanding of structural and functional neuroembryology.
• Familiarity with available neurodiagnostic tools.
• Experience with long-term neurodevelopmental outcomes of common fetal phenotypes.
• Knowledge of environmental threats to the developing fetal brain and the normal/pathological intrauterine milieu.
• Understanding of basic obstetrics, transitional physiology and pathophysiology, and potential brain hazards for fetuses and newborns with congenital anomalies.
• Counseling requires awareness of legal, cultural, religious, and ethical considerations.

Current Practice and Future Role:

• Heavily influenced by standard obstetric protocols for fetal imaging, which vary regionally.
• Most fetal neurological concerns arise during mid-gestation anatomy screening ultrasounds, leading to lesion-driven consultations.
• Future likely to involve a more active role in brain-oriented care for high-risk populations, such as fetuses with growth restriction, birth defects, and complicated twin pregnancies.
• Focus on conditions detectable in the fetal period rather than those diagnosed at birth or early infancy.