Hot Topics in Perinatal Medicine

Obesity epidemic is a global problem of the 21th century for women in reproductive age and also the obstetricians and pediatricians. There are influences of mother's prepragnancy and antepartal obesity, at delivery, for fetal programming and for maternal and fetal lifelong metabolism. The epidemiological results are important, but for the health care providers the skills for prevention of mother's obesity with all consequences are essential. Evaluated programms in nutrition and physical activity will be discussed.

Die Perinatale Medizin ist ein wissenschaftshistorisch gesehen noch junges Fachgebiet der Medizin, das sich seit Mitte des 20. Jahrhunderts herausgebildet hat. Wesentliche Anstöße und Innovationen verdankt sie dem wissenschaftlich-ärztlichen Wirken eines der Herausgeber des Bandes, Prof. Dr. Erich Saling, der auch "Vater der Perinatalen Medizin" genannt wird. Er hat mit der Einführung der Fetalblutanalyse erstmals einen Zugang zum Ungeborenen eröffnet, was heute als Meilenstein am Beginn der Perinatalen Medizin gilt.
Mit Ausnahme der 1985 erschienenen Aufsatzsammlung von Rooth und Saugstadt existieren zur Geschichte der Perinatalen Medizin nur Einzeldarstellungen unterschiedlicher Teilgebiete (z.B. fetale Überwachung sub partu, Ultraschall), entweder als Paper in Zeitschriften oder Kapitel in entsprechenden Lehrbüchern erschienen. Bislang gibt es jedoch kein Werk, das in einem integrativen Zusammenhang die Geschichte des noch jungen Fachs mit Schwerpunkt auf dem Beginn in den 1960er und frühen 1970er Jahren aber auch unter Würdigung wesentlicher Vorläufer und kurzer Darstellung der späteren Entwicklungen aus der Sicht einiger Beteiligter darstellt.
Die Autoren des Bandes sind ausgewiesene Fachleute mit teilweise jahrzehntelanger Expertise auf den von ihnen beschriebenen Feldern.

Different technologies have been introduced to improve management of labor. To date there is no single text that aims at covering all these technologies that address different problems and issues in labor management.

The book reviews new technologies and devices aimed to improve labor management and outcomes. These diverge between looking at a better way to use fetal heart rate monitors (that are used in 90% of labours); using new monitors to detect the <1% of babies that are damaged in labor and account for 99% of the medico-legal costs in labor; and early detection of non-progressive labors that complicate 30-50% of labors. This is the only book about all these technologies from the perspectives of new devices and technologies in labor.

This book provides the first clinically comprehensive and practical approach to ethical challenges in perinatal medicine. The first chapter introduces and explains the professional responsibility model of perinatal ethics. The professional responsibility model is based on the medical ethics of two major physician-ethics in the history of Western medical ethics, Dr. John Gregory (1724-1773) of Scotland and Dr. Thomas Percival (1740-1804) of England. The professional responsibility model is used to articulate the ethical concept of the fetus as a patient and to operationalize the ethical principles of beneficence and respect for autonomy. The book provides practical guidance for clinical judgment and decision making with patients about the responsible clinical management of the wide range of issues encountered by perinatologists in clinical practice and research. Topics included: periviability; feticide; intrapartum management; maternal-fetal conflict; innovation for fetal benefit; research for fetal benefit; non-aggressive obstetric management; managing the transition from pregnancy to birth; destructive procedures such as cephalocentesis; critical care for the pregnant patient; home birth; patient-choice cesarean delivery; neonatal care as a trial of management; and setting limits on neonatal care on the basis of clinical judgments of futility.

Abnormal placental adhesive disorders are associated to massive hemorrhage and high maternal morbidity and mortality. The main risk factor for abnormal invasive placentation is the repeated cesarean, although other factors were identified. There are specific techniques to provide a high confidence diagnosis. However, precise skills must be acquired to recognize detailed diagnostic signs, to avoid common technical mistakes, and also to know when, how and why it is necessary to use each of them. Presurgical study provides diagnosis, extension and compromise of neighboring structures such as the bladder or the parametrium. Knowledge of placental invasion extension is needed to plan any resective surgery such as hysterectomy or one-step conservative surgery. Due to the fact that topography of the invaded area has direct relation with the specific arterial pedicles, a map of the invasion is required to know which type of proximal vascular control can be more effective. Leaving the placenta in situ seems to be the best option when resources or a skilled team are not available, but it requires intensive postoperative controls to detect infection, bleeding or coagulation disorders. Hysterectomy can be an easy solution for non-experimented operators; however, it is usually a very complicated procedure with demonstrated morbidity and mortality due to hemodynamic and hemostatic problems.

This book gathers the latest knowledge in relation with the etiology, diagnosis, treatment and also the authors personal experience in more than 500 cases. All aspects of this condition have been analyzed to provide an accurate management, which includes vascular control, urology, anesthesia and hemodynamic management among others.