Diagnosis and Treatment of Fetal Disorders Proceedings of the Intern
HOWARD C. TAYLOR, JR. Medicine, through its long history, has continually striven to enlarge its scope. Success in these endeavors has come in sudden bursts with long intervals of relative quiescence between. As a result of the spectacular discoveries in
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DIAGNOSIS AND TREATMENT OF FETAL DISORDERS Proceedings of the If}ternational Symposium on Diagnosis and Treatment of Dfsorders Affecting the Intrauterine Patient Dorado, Puerto Rico, October 29--31, 1967
Edited by Karlis Adamsons HELD UNDER THE AUSPICES OF THE DEPARTMENT OF OBSTETRICS AND GYNECOLOGY, COLLEGE OF PHYSICIANS AND SURGEONS, COLUMBIA UNIVERSITY, ON THE COMMEMORATION OF ITS BICENTENNIAL
Springer-Verlag New York Inc.
ISBN-13: 978-3-642-46174-3
e-ISBN-13: 978-3-642-46172-9
001: 10.1007/978-3-642-46172-9
All rights reserved. No part of this book may be translated or reproduced in any form without written permission from Springer-Verlag. © 1968 by Springer-Verlag New York Inc. Softcover reprint of the hardcover I st edition 1968 Library of Congress Catalog Card Number 69-15821
Foreword HOWARD
C.
TAYLOR,
JR.
Medicine, through its long history, has continually striven to enlarge its scope. Success in these endeavors has come in sudden bursts with long intervals of relative quiescence between. As a result of the spectacular discoveries in the basic sciences during the last decades, medicine is again in a period of revolutionary advance in many fields. One of these is the subject of this report, "The Intrauterine Patient." Until recently the fetus signalized his presence only by the mother's enlarging abdomen and by his own movements, perceived by the pregnant woman herself and evident to the examining midwife and physician. Later, the sounds of the fetal heart heard by auscultation and the variations in its rate became the single important means by which the welfare of the fetus might be roughly determined and threats to his survival perhaps detected. Otherwise, the fetus remained isolated, his condition unknown and any therapy consequent on diagnosis, except for the induction or termination of labor, nonexistent. All of this is now changing as methods to determine fetal welfare and monitor his progress during pregnancy and labor are developed. The most important of the new methods are reviewed in this collection of the papers presented at the symposium held in Puerto Rico in October 1967. The new methods include direct approach to the placenta by biopsy, examination of fluid obtained through amniocentesis, blood sampling from the fetal scalp, and the measurements of certain biochemical changes in the mother regarded as reflections of fetal metabolism. Radiography and fetal electrocardiography are achieving new levels of perfection. The "treatment" of the fetus, as in so many aspects of medicine, advances more slowly than does diagnosis, but in an indirect sense is not so new. The therapy of predictable congenital syphilis, for example, was accomplished by inference, without access to the fetus. Now, however, therapy is becoming more directly related to diagnosis. The treatment of erythroblastosis depends on the analysis of fluid obtained by amniocentesis. Hormone determinations carried out on the mother's urine v
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FOREWORD
and acid-base studies of the fetal scalp blood have provided data whi
