Prenatal Medicine PDF

Preface

The goal of obstetrical care—regardless of all the medical, surgical, and technical advances of the past 50 years—still remains the delivery of healthy infants and the maintenance of good maternal health. Because those of us who practice obstetrics usually care for young, healthy women, this goal is one that is usually attained.

However, congenital and acquired maternal and fetal diseases are not uncommon complications during many pregnancies. Although maternal–fetal specialists and geneticists provide the care for those women with maternal conditions that can affect fetal or maternal well being or those women found to be carrying fetuses with congenital and acquired abnormalities, such complications can and do arise during the care of the ostensibly normal pregnancy. Indeed, lifestyle considerations such as nutritional status, maternal age, and an increasing recognition of specific genetic factors in the predisposition of fetal, newborn, and maternal conditions as a result of the Human Genome Project have considerably altered the delineation of low-risk and high-risk pregnancies.

Recognizing that such new and novel advances in our knowledge of maternal and fetal physiology have lead to profound changes in obstetrical management of low- and high-risk pregnancies, we sought to assemble a compilation of the state-of-the-art of prenatal care.We recognized, however, that such advances had led to considerably different approaches to incorporating this information into clinical practice. Therefore, to provide the most accurate presentations of the clinical applications of these novel advances, we utilized our rather disparate clinical and research experiences to recruit an international group of researchers and clinicians who could present an accurate overview of these advances as they apply to a variety of patients, clinical scenarios, and distinct communities of genetically and socially different peoples. We believe that presenting a wide and realistic spectrum of obstetrical practice and research is the best way for our colleagues to determine the best approaches for incorporating this information into their practices. In this way, Prenatal Medicine represents a unique and dynamic approach to the challenge of effectively incorporating novel and recent scientific information into the care of pregnant women worldwide.

Although many can agree on the scientific concepts that continue to change and improve our care of pregnant women and fetuses in all stages of pregnancy, one aspect that will assuredly divide clinicians is the legal and political differences that separate us. Whether the result of geographical boundary or personal conviction, these differences will continue to color and, at times, direct the care of women and their pregnancies. To this end, we also present different legal and political approaches to obstetrical care and seek to engage in dialogue that will hopefully spark lively discussion among colleagues and ultimately improve the care of all pregnant women.

We are indebted to the authors of the chapters, who not only provided outstanding reviews of their particular areas of expertise, but also serve as outstanding clinicians, teachers, mentors, and researchers. Their work improves the care of their patients, and through texts such as Prenatal Medicine, may improve the care of women far from their homes, offices, and communities.

The ongoing improvement in medical care relies on all practitioners to commit to lifelong learning. We hope that Prenatal Medicine will be a component of that commitment and serve as a resource and motivation for the appropriate incorporation of new and novel scientific advances that will improve the care of women and fetuses no matter where they live.