Clinical Review Recent advances

Fetal medicine

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7144.1580 (Published 23 May 1998) Cite this as: BMJ 1998;316:1580
  1. David James, professor of fetomaternal medicine
  1. Queen's Medical Centre, Nottingham NG7 2UH
  • Accepted 14 January 1998

Introduction

In the 13 years since the first annual symposium of “The Fetus as a Patient,” diagnostic skills with fetal disease have improved enormously, but therapeutic approaches remain limited. Periconceptual folate, maternal steroids, and fetal blood transfusion are the best examples of preventive, transplacental, and invasive treatments, respectively, and all three were developed more than a decade ago.

Arguably, the most significant advance is that most professionals and parents consider the fetus as a separate individual and a potential patient in his or her own right. Indeed, once the fetus is recognised to be at risk the perinatal outcome is better than in an apparently low risk pregnancy.1 Antepartum “unexplained” fetal death is by far the commonest cause of death between 20 weeks' gestation and the age of one year, comprising nearly 40% of deaths in this period.2 The main challenge in pregnancy care is to improve fetal surveillance in low risk pregnancies so that potentially compromised fetuses can be identified.

Methods

In most sections of this review, the references were chosen after a systematic review of the literature of the past eight years. My Medline search (with Ovid) used the keywords fetal assessment, fetal monitoring, twin pregnancy, amnioinfusion, fetal therapy, and fetal awareness. For the sections on fetal assessment and amnioinfusion I also used the Cochrane Library. The references (except on fetal pain, for which there were few references) were chosen to reflect all management options and include, where possible, randomised controlled trials.

Fetal assessment

Though advances in fetal treatment are limited, progress in fetal evaluation has been considerable. The use of umbilical artery Doppler ultrasonography in the assessment of high risk pregnancies approximately halves the perinatal death rate in normally formed babies.3 Antepartum monitoring of fetal heart rate, though the most widely used method of fetal assessment in late …

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