Antenatal and Intrapartum Care of the High - Risk Infant

Parallel to the significant improvements in care of the premature and sick neonate, extensive technology concerned with the evaluation and supervision of the high-risk fetus has developed. 3 5 , 150. 153,180 Initially stimulated in the 1960s by the pioneering work with amniotic fluid analysis in Rh-isoirnmunized pregnancy, this technology has evolved and expanded at a rapid rate. Hormonal assessments of fetoplacental function; fetal scalp blood determinations of fetal homeostasis, electronic monitoring of the fetal heart rate (FHR) during and before labor; biochemical estimations of fetal pulmonary maturity; ultrasonic measurements of fetal head size, fetal growth, and fetal activity; and detailed ultrasonic evaluation of fetal anatomy have all become commonplace prooedures.v 8, 57 The inner sanctum of the fetus has been penetrated and it has become commonplace to detect many genetic and antenatal abnormalities before delivery. Visualization of the fetus by fetoscopy and ultrasonic recording of fetal respiration, tone, and state, together with monitoring of fetal behavioral responses are an integral part of antepartum care. Detailed studies of fetal cardiac and renal anatomy and function present valuable information to the perinatal team. 52, 53 The capabilities of accurate diagnosis and treatment of fetal disorders have expanded rapidly so that fetal blood sampling, major surgical interventions such as repair of a diaphragmatic hernia, and excision of CCAM (congenital cystic adenomatoid malformation) or even correction of neural tube defects may be accomplished without interrupting the pregnancy. 55, 69, 71 Furthermore, intravascular transfusions for Rh isoimmune fetal anemia or other causes of reversible fetal anemia as well as medical treatment of fetal arrhythmias are possible.