Gynecological Surgery

Maternal/Fetal medicine

Maternal/Fetal medicine

This field of medicine is also known as perinatology and deals on managing the concerns of the mother and fetus during and shortly after pregnancy. The specialists who deal with Maternal-fetal medicine are generally with in the field of obstetrics. They act as consultants especially during high- risk and low-risk pregnancies. They work closely with paediatricians or neonatologists after birth. For the mother, they assist with pre-existing health concerns as well as complications caused by pregnancy.

These specialists attend to patients who fall within certain levels of maternal care where levels correspond to health risks for the baby, mother, or both during pregnancy. These specialists take care of women who are having hearth diseases, kidney diseases, hypertension, diabetes and thrombophilla. They also deal with mother’s pre-existing health conditions, such as blood pressure, dug use before and after pregnancy. In addition women facing difficulty with conceiving may be referred to a maternal-fetal specialist.

Amniotic Fluid Dynamics: Amniotic fluid (AF) is necessary for normal human fetal growth and development. It protects the fetus from mechanical trauma, and its bacteriostatic properties may help to maintain a sterile intrauterine environment. The space created by the AF allows fetal movement and aids in the normal development of both lungs and limbs. Finally, AF offers convenient access to fetal cells and metabolic by products and therefore has been used for fetal diagnoses more often than any other gestational tissue. The existence of AF has been appreciated since ancient times. Leonardo drew the fetus floating in the fluid, and William Harvey hypothesized that the fetus was nourished by it. Only in the late 19th century, however, did AF become available for study other than at delivery, and fl uid sampling by amniocentesis was rarely performed until the second half of the 20th century. Genetic amniocentesis for fetal sex determination was first performed in 1956.1 Research on the characteristics of AF is therefore a relatively recent development. This chapter reviews the current state of knowledge regarding the volume, composition, production, resorption, and volume regulation of AF.

Multiple Gestation:

Incidence of Twinning The incidence of twinning is increasing as our population ages and a new technology—assisted reproductive technology (ART)—is becoming widely used. Not only have artificial reproductive techniques led to a marked increase in higher-order multiple births (triplets, quadruplets) but also they are followed by an increase in prematurity rates and congenital anomalies.1-3 The statistics, which are usually derived from national or regional birth records and rely on reporting by physicians or other personnel attending births, do not accurately reflect the occurrence of twins at conception because the much higher prenatal mortality of twins (as abortion or fetus papyraceus) is not taken into account. Thoughtful reviews of the multiple gestation “epidemic” are available.4-6 Some countries have chosen to deny transfer of more than one blastocyst.7 An additional fi nding of interest is that there appears to be an increase in monozygotic twinning (identify-ed as being monochorionic) when various ART procedures are used; also, placental abnormalities are more frequent.8 Guttmacher9 suggested that 1.05% to 1.35% of pregnancies were twins, the reason for this wide variation being that the frequency of the twinning process varies widely among different populations. Data collated from various countries reveal that the variability relates largely to the ethnic stock of the population under consideration. Moreover, although the dizygotic (DZ) twinning rate varies widely under different circumstances, the monozygotic (MZ) twinning rate is considered to be “remarkably constant,” usually between 3.5 and 4 per 1000,10 although Murphy and Hey11 found the rate to have slightly increased in recent years. In recent national statistics, of 4 million births in the United States, 3.3% were multiple or 1 in 30 gestations. When the twinning rate of a population is known, the frequencies of triplets, quadruplets, and so on can be roughly calculated by Hellin’s hypothesis, which states that when the frequency of twinning is n, that of triplets is n2 , of quadruplets n3 , and so on. The highest number recorded so far is nine offspring.12 Since 1973, there has been a steady rise in the incidence of twins and triplets, so that currently at least 1 in 43 births is a twin and 1 in 1341 pregnancies results in triplets.2,13 In part, this increase was attributed to delayed childbearing, but the use of ovulation-enhancing drugs has also been implicated. Although acknowledging the increased DZ twinning frequency attributed to clomiphene, Tong and coworkers14 found that the DZ-to-MZ ratio has significantly declined from 1.12 (1960) to 0.05 (1978) and suggested adverse environmental factors as a possible cause.

Abnormalities of Twin Gestation

Fetus Papyraceus: When one or more of the fetuses in a multiple gestation dies before birth and the pregnancy continues, the fluid of the dead twin’s tissues is gradually absorbed, the amniotic fluid disappears, and the fetus is compressed and becomes incorporated into the membranes. Hence, it is called a fetus compressus, fetus papyraceus, or membranous twin. The condition occurs in both DZ and MZ twins and is a regular fi nding when multiple gestations are surgically reduced. This has become much more common in recent years as many fetuses are conceived with ART. Acardiac Twin: The most bizarre malformation recorded, acardiac twin, occurs only in one twin of a pair of MZ twins. 

Related conferences:

Gynecology Congress 2018, on August 22-23, 2018 Tokyo, Japan

Gynecologic Congress 2018, on July 23-24, 2018 Rome, Italy

Advanced Nursing Science 2018, Conference on April 20-21, 2018 Las Vegas, USA

Nursing & Healthcare Congress 2018, on April 23-25, 2018 Dubai, UAE

Neonatal Nursing Congress 2018, on May 14-15, 2018 Singapore

Midwifery Congress 2018, on May 11-12, 2018 Osaka, Japan

Gynecology and Obstetrics Pathology 2018, Conference on March 30-31, 2018 Orlando, USA

Midwifery 2018, Summit on September 26-27, 2018 Chicago, USA

Breast Pathology 2018, Conference on June 25-26,2018 Vancouver, Canada

Nursing Global 2018, Summit on March 01-03, 2018 London, UK