Editor's Corner

Advances in Fetal-Maternal Medicine

by Michael E. Speer, MD
Professor of Pediatrics–Neonatology

Not all that long ago, the only clinical tools to assess a fetus were measuring uterine growth and auscultating fetal heart tones. Neither method could be accomplished before the second trimester. Now, however, potential fetal intervention runs the gamut from chorionic villus sampling to fetal surgery.

In this issue, Dr. Carpenter notes the advances made in twin-twin transfusion syndrome through carefully conducted clinical trials. Using fetal ultrasound, physicians are able to identify the presence of abnormal fetal development, including cardiac defects, early in gestation. Early pregnancy ultrasound also has helped to

• elucidate the causes of fetal hydrops,
• determine gestational age, and
• ascertain the presence of probable chromosomal anomalies.

Using a fixed detection rate of 85% for Trisomy 21 and a combination of maternal age, nuchal translucency, and biochemical markers, the false positive rate can be as low as 1% for the detection of this disorder.

Use of fetal transfusion for anemia is commonplace.

Stem cell therapy is in its infancy, as is fetal surgery.

The role of the placenta in contributing to developmental effects and fetotoxicology is enjoying renewed interest.

Additionally, over the next several years we will embark upon a new journey — functional genomics and proteomics. This is a systematic and comprehensive approach to the identification and description of the processes and pathways involved in physiological states. Using this technology, possible biomarkers of pre-eclampsia, preterm labor, and gestational trophoblastic diseases have been discovered.

The combination of advances in fetal-maternal medicine coupled with those in neonatology will improve not only fetal health but neonatal outcomes as well.