Diagnosis and Treatment of Fetal Disorders: Proceedings of the International Symposium on Diagnosis and Treatment of Disorders Affecting the Intrauterine Patient Dorado, Puerto Rico, October 29–31, 1967 PDF
Preview Diagnosis and Treatment of Fetal Disorders: Proceedings of the International Symposium on Diagnosis and Treatment of Disorders Affecting the Intrauterine Patient Dorado, Puerto Rico, October 29–31, 1967
DIAGNOSIS AND TREATMENT OF FETAL DISORDERS DIAGNOSIS AND TREATMENT OF FETAL DISORDERS Proceedings of the Intemational Symposium on Diagnosis and Treatment of Disorders 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 Science+Business Media, LLC ISBN 978-3-662-24268-1 ISBN 978-3-662-26381-5 (eBook) DOI 10.1007/978-3-662-26381-5 All rights reserved. No part of this book may be translated or reproduced in any form without written permission from Springer Science+B usiness Media, LLC. © 1968 by Springer Science+Business Media New York Originally published by Springer-Verlag New York, Inc. in 1968 Softcover reprint of the hardcover 1st edition 1968 Library of Congress Catalog Card Number 69-15821 Title Number 1548 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 preg nant woman herself and evident to the examining midwife and physician. Later, the sounds of the fetal heart heard by auscultation and the varia tions in its rate became the single important means by which the welfare of the fetus might be roughly determined and threats to his survival per haps detected. Otherwise, the fetus remained isolated, his condition unknown and any therapy consequent on diagnosis, except for the induc tion 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 bio chemical changes in the mother regarded as reflections of fetal metab olism. 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, how ever, therapy is becoming more directly related to diagnosis. The treat ment of erythroblastosis depends on the analysis of fluid obtained by amniocentesis. Hormone determinations carried out on the mother's urine v vi FOREWORD and acid-base studies of the fetal scalp blood have provided data which are leading to a sound set of indications for early delivery. In the collection of papers in this volume, one can see the outlines of a new branch or subspecialty in medicine. What its final name will be seems uncertain. The medicine of the "intrauterine patient" is a pleasant, expressive, but probably temporary term. "Fetology" seems still a trite contrivance. But the question of nomenclature is trivial. What is impor tant is to note that medicine has successfully entered a new area and opportunities exist for its rapid and continued development. The present volume shows how much has already been done and what prospects lie ahead. Introduction KARLIS ADAMSONS The recent identification of the fetus as a discrete patient within the reach of diagnostic and therapeutic procedures has led to a substantial growth of information on human development prior to birth. Progress has been particularly rapid during the last few years since the disappearance of the hitherto almost mystical attitude toward the fetus. This has made it possible to apply advanced biophysical and biochemical techniques to the study of prenatal events. In order to obtain an overview of this new field which extends from the detection of genetic disorders in the early embryo to the correction of abnormalities in the more mature fetus by direct surgical intervention, it appeared desirable to gather the opinions of noted investigators regard ing the goals already achieved and the future potential of prevention, diagnosis and the treatment of fetal disorders. This volume is the product of such an effort. Hallmarked as proceedings, this collection of contributions of selected participants of a symposium departs in some respects from the traditional form of reporting the transactions of a conference. For the sake of brevity the sections on discussion were deleted, unless the material was of suffi cient import to qualify them as independent papers. The contributors, however, were urged to incorporate the highlights of the discussion into their manuscripts, and the session chairmen were granted the privilege to submit an implementing paper after reviewing the verbatim transcript of the proceedings. It was hoped that by adhering to these guide lines the reader of this volume would be provided with a rather complete account of the scientific events of the conference. The editor wishes to convey his appreciation to the authors, who have found time in their heavily committed schedules to prepare the manu scripts, to his friends and advisers, Kurt Benirschke, Joseph Dancis, Stan ley James and Jerold Lucey, for their editorial assistance, to Eileen Has selmeyer from the National Institute of Child Health and Human Devel- vii viii INTRODUCTION opment for her help and guidance in organizing the symposium, to the sponsors for their financial support, to Miss Martha Baker for her invalu able aid in proofreading the galleys and to the staff of Springer-Verlag for its promptness and cooperation. New York City December 1968 Participants Karlis Adamsons, M.D., Ph.D. (Chairman) Associate Professor of Obstetrics and Gynecology Columbia University Herm6genes Alvarez, M.D., F.A.C.S. William A. Blanc, M.D. Dean Faculty of Medicine, Professor of Pathology Professor of Obstetrics and Columbia University Gynecology Universidad de La Republica, Uruguay Edward T. Bowe, M.D. Assistant Professor of Obstetrics and Gynecology Stanley H. Asensio, M.D. Columbia University Associate Professor of Obstetrics and Gynecology University of Puerto Rico Audrey K. Brown, M.D. Professor and Vice Chairman of Pediatrics Richard W. Beard, M.B., M.R.C.O.G. Medical College of Georgia, Senior Lecturer Director of Pediatric Hematology, Queen Charlotte's Hospital Eugene Talmadge Memorial Hospital, London University Augusta, Georgia Kurt Benirschke, M.D. Roberto Caldeyro-Barcia, M.D. Professor and Chairman of Pathology Professor and Chairman of Dartmouth Medical School Physiopathology, Director, Service of Obstetrical Walter Berdan, M.D. Physiology Associate Professor of Radiology University of Uruguay Columbia University Arsenio C. Comas-Urrutia, M.D. Samuel Bessman, M.D. Chief Resident, Professor and Chairman of Department of Obstetrics and Developmental Medicine Gynecology University of Maryland University of Puerto Rico ix X PARTICIPANTS Joseph Dancis, M.D. Harold P. Klinger, M.D., Ph.D. Professor of Pediatrics Associate Professor of Genetics New York University Albert Einstein College of Medicine Juan G. Figueroa-Longo, M.D. Jerold F. Lucey, M.D., F.A.A.P. Assistant Professor of Professor of Pediatrics Obstetrics and Gynecology University of Vermont University of Puerto Rico Ann M. Boyer Milic, M.D. James R. Fouts, Ph.D. Research Fellow in Professor of Pharmacology Obstetrics and Gynecology University of Iowa, Columbia University Program Director of the Oakdale Toxicology Center Orlando J. Miller, M.D. Vincent J. Freda, M.D. Associate Professor of Assistant Clinical Professor of Obstetrics and Gynecology Obstetrics and Gynecology Columbia University Columbia University J. George Moore, M.D. Peter Gruenwald, M.D. Professor and Chairman of Associate Professor of Pathology Obstetrics and Gynecology Johns Hopkins University Columbia University Erlio Gurpide, Ph.D. Assistant Professor of Biochemistry Ronald E. Myers, M.D., Ph.D. Chief, Laboratory of Perinatal Columbia University Physiology Eileen G. Hasselmeyer, Ph.D., R.N. National Institute of Special Assistant for Prematurity and Neurological Diseases and Blindness Acting Director, Perinatal Biology National Institutes of Health and Infant Mortality Branch N ationallnstitute of Child Health Adan Nigaglioni, M.D. and Human Development Chancellor, University of Puerto Rico Medical Sciences Campus, and S. Glennis Haworth, M.D. Professor of Medicine Research Fellow in Pediatrics Columbia University Antonio Ortiz, M.D. Edward H. Hon, M.D. Professor and Chairman of Pediatrics Associate Professor of University of Puerto Rico Obstetrics and Gynecology Giorgio Pardi, M.D. Yale University Assistant Professor L. Stanley James, M.D. Il Clinica Ostetrica e Ginecologica Professor of Pediatrics University of Milano Columbia University John B. Josimovich, M.D. Ivan A. Pelegrina, M.D. Associate Professor of Professor and Chairman of Obstetrics and Gynecology Obstetrics and Gynecology University of Pittsburgh University of Puerto Rico
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