Table Of ContentDIAGNOSIS 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
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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
