Up to the spring of 1990 more than 60,000 chorionic villus samplings (CVS) in the
first trimester (1) and more than 2,000 in the second and third trimesters (2) had been
Progress in molecular biology and biotechnology has created promising possibilities
for the analysis at the DNA level of basic defects underlying many genetic
The ultimate goal for prenatal diagnosis is treatment of the affected fetus to correct
the defect. For many disorders it is unlikely that effective corrective or preventative
therapy will be developed in the foreseeable future.
Ultrasound is already an essential component of obstetric evaluation, but is gaining
even more attention as Doppler techniques open new avenues into the diagnosis of
blood flow disturbances in the fetus.
During the last 10 years magnetic resonance imaging (MRI) has gradually become
established as a useful diagnostic procedure in clinical medicine. In the study of
disease in the central nervous system, in the skeleton, and in many other organs in
the body, high-resolution pictures have been obtained which are of inestimable use
to those concerned with clinical management.
The use of diagnostic ultrasound in obstetrics started in the late 1960s and became
universally accepted over the next 10 years.
Decisions to intervene during pregnancy or labor because of fetal distress can be
determined by many factors such as maternal hypertension, fetal growth retardation,
a decrease in fetal movements, a diminished amount of amniotic fluid, an abnormal
blood flow in fetal or umbilical vessels, and an abnormal fetal heart rate pattern.
Dr. Redman and I joined forces to undertake a computerised evaluation of antenatal
fetal heart rate (FHR) traces (with tocodynamometer and fetal movement
counts) in 1978.
The routinely used cardiotocography (CTG) has been criticized for the effect of
leading to an unacceptably high number of cesarean sections (1,2). Information on
biochemical variables leads to better identification of fetal distress (3-5).
Our ability to identify the fetuses at risk of intrapartum asphyxia depends on either
monitoring the actual level of hypoxemia using biochemical means or, by different
techniques, interpreting the reactions caused by hypoxemia.
One of several high priorities in clinical obstetrical research is the determination
of the proportion of preterm deliveries caused by infection. If infection can be shown
with a high degree of certainty to be a significant cause, and if the mechanisms are
understood, a safe therapeutic scheme can be proposed to reduce the incidence of
The rate of premature delivery has remained essentially unchanged over the last
30 years (1). The magnitude of the problem is illustrated by the fact that only 1% of
infants are born premature, but these premature infants account for 80% of the perinatal
During the past few years it has been recognized more and more that ascending
genital infection is an important factor in the etiology of prematurity. This is confirmed
in a number of reports in the literature.
Clinical perinatology to a large extent concerns itself with the maintenance of
normal respiratory gas exchange for fetus and neonate via placenta and lungs. Disturbances
in the function of these organs account for most perinatal morbidity and
There is no doubt that cerebral ultrasound has proved an extremely useful technique
for the neonatologist, who is increasingly concerned not only with reducing
perinatal mortality but also with improving the quality of neonatal survival.
Surfactant deficiency at birth makes it difficult for the newborn to inflate its lungs.
As the infant makes increasingly vigorous attempts to ventilate noncompliant lungs,
delayed adsorption of lung fluid, pulmonary edema, extravasation of plasma proteins
into air spaces, and lung injury occur, which cause progressive respiratory distress.
Intratracheal administration of surfactant into the infant's lungs is a reasonable approach
to replenish the missing surfactant.