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The Evolution of prenatal assessment.

It is astonishing how much obstetrics and maternal-fetal medicine have grown. There was a time not too long ago when obstetric care was primarily delivered to the mother, with the fetus being a hopeful beneficiary. We could listen to the fetal heart rate using the fetoscope, but access to the fetus for its early developmental analysis was otherwise off-limits; its growth and development were assumed as part of maternal-focused obstetric care.

The introduction of electronic fetal monitoring gave us the opportunity to see a recording of the fetal heart rate pattern - its rhythm, and its quality - and we used that as an indirect measure of fetal well-being. Subsequently ultrasound became available, and we could then evaluate the anatomy of the fetus - though usually in the latter part of pregnancy - and appreciate the morphology and overall growth performance.

It was not until relatively recently that the focus of prenatal assessment has shifted to the first trimester. In large measure, this change has been consumer driven. Families have become very interested in the development of their unborn children, and that interest increasingly has centered on obtaining more information earlier on. Such demand has pushed physician scientists working in the field to adapt their technologies to the first trimester. Recent research has, in large measure, advanced in response to parental interests.

Fetal diagnosis in the first trimester was thus born of this great desire and has evolved to the point where, as stated in this month's Master Class, it is becoming the standard of care. The field of first-trimester fetal diagnosis now consists of a series of biochemical and biophysical assessments that can truly evaluate fetal well-being at the current time and can contribute to the prediction of later development and later fetal well-being, or more importantly, the loss of fetal well-being.

It is in light of this burgeoning field of first-trimester evaluation that we decided to develop a Master Class to review this new state of the art. I have invited Dr. Christopher R. Harman, an international expert in the field of ultrasound and Doppler technology, to serve as this month's guest professor.

Dr. Harman is professor and interim chair of the department of obstetrics, gynecology, and reproductive sciences at the University of Maryland, Baltimore, as well as director of the school's maternal-fetal medicine division. He will explain how research is honing in on a first-trimester platform of assessments that holds even more potential for predicting risks and complications than we realized with the first-trimester screening algorithm that took hold more than 5 years ago.


DR. REECE, who specializes in maternal-fetal medicine, is vice president for medical affairs at the University of Maryland, Baltimore, as well as the John Z. and Akiko K. Bowers Distinguished Professor and dean of the school of medicine. He said he had no relevant financial disclosures. He is the medical editor of this column. Contact him at
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Title Annotation:MASTER CLASS
Author:Reece, E. Albert
Publication:OB GYN News
Date:May 1, 2011
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