Seminars in Perinatology via MedWorm.com

The Evolution of Early Hearing Detection and Intervention Programs in the United States

Seminars in Perinatology — Mon, 08 Mar 2010 17:41:29 +0100

This article reviews the history of newborn hearing screening programs in the United States, summarizes the content of legislation and regulations passed by states related to universal newborn hearing screening, and describes how well each National Goal has been addressed. Although substantial progress has been made in the percentage of infants screened for hearing loss before hospital discharge, significant improvement is needed with respect to the availability of pediatric audiologists, implementation of effective tracking and data management systems, program evaluation and quality assurance, availability of appropriate early intervention programs, and linkages with medical home providers. (Source: Seminars in Perinatology)

Digital Microfluidics: A Future Technology in the Newborn Screening Laboratory?

Seminars in Perinatology — Mon, 08 Mar 2010 17:41:29 +0100

We describe a cost-effective new platform that reduces the time to result reporting and can perform multiplexing assays requiring different platforms. Immunoassays and enzyme activity assays currently used in newborn screening have been translated to a disposable microchip programmed to dispense, transport, mix, wash, and incubate individual microdroplets from specimens, including dried blood spot extracts, and reagents all under software control. The specimen and reagents consumed are approximately 1% of those required by equivalent bench assays. In addition to immunologic and enzymatic assays, DNA amplification, amplicon detection, and sequencing have been demonstrated using the same microchips and control equipment. Recently, the multiplexing of 4 different enzyme activities has also be...

Enhancing the Quality and Efficiency of Newborn Screening Programs Through the Use of Health Information Technology

Seminars in Perinatology — Mon, 08 Mar 2010 17:41:29 +0100

In this study, we address steps being taken to understand these challenges, outline progress made to date to overcome them, and provide examples of how electronic health information exchange will enhance the utility of newborn screening. It is likely that future advances in science and technology will bring many more opportunities to prevent and preempt disabilities among children through early detection programs. To take their advantage, effective communication strategies are needed among the public health, primary care practice, referral/specialty service, and consumer advocacy communities to provide continuity of information required for medical decision-making throughout prenatal, newborn, and early childhood periods of patient care. (Source: Seminars in Perinatology)

Newborn Screening Progress in Developing Countries—Overcoming Internal Barriers

Seminars in Perinatology — Mon, 08 Mar 2010 17:41:29 +0100

Newborn screening is an important public health measure aimed at early identification and management of affected newborns thereby lowering infant morbidity and mortality. It is a comprehensive system of education, screening, follow-up, diagnosis, treatment/management, and evaluation that must be institutionalized and sustained within public health systems often challenged by economic, political, and cultural considerations. As a result, developing countries face unique challenges in implementing and expanding newborn screening that can be grouped into the following categories: (1) planning, (2) leadership, (3) medical support, (4) technical support, (5) logistical support, (6) education, (7) protocol and policy development, (8) administration, (9) evaluation, and (10) sustainability. We re...

History and Current Status of Newborn Screening for Hemoglobinopathies

Seminars in Perinatology — Mon, 08 Mar 2010 17:41:29 +0100

The impact of hemoglobinopathies on healthcare in the United States, particularly sickle cell disease (SCD), has been significant. Enactment of the Sickle Cell Anemia Control Act in 1972 significantly increased the federal interest in the SCDs and other hemoglobinopathies. Only since May 1, 2006, have all states required and provided universal newborn screening for SCD despite a national recommendation to this effect in 1987. In this article, we review the history of screening for SCD and other hemoglobinopathies, along with federal and state activities that have contributed to improved health outcomes for patients with SCD, as well as current newborn screening practices. We also chronicle the federal activities that have helped to shape and to refine laboratory screening and diagnostic pr...

Improving and Assuring Newborn Screening Laboratory Quality Worldwide: 30-Year Experience at the Centers for Disease Control and Prevention

Seminars in Perinatology — Mon, 08 Mar 2010 17:41:29 +0100

This report reviews the Program's milestones and services to the newborn screening community. (Source: Seminars in Perinatology)

From Developing Guidelines to Implementing Legislation: Actions of the US Advisory Committee on Heritable Disorders in Newborns and Children Toward Advancing and Improving Newborn Screening

Seminars in Perinatology — Mon, 08 Mar 2010 17:41:29 +0100

This article describes the Secretary's Advisory Committee on Heritable Disorders in Newborns and Children. Its history offers insight into connection of the development of policy guidelines and the creation of legislation to implement that policy. Its current activities have affected and will continue to affect not only state newborn screening programs but also the policy and practice of screening children for heritable disorders. (Source: Seminars in Perinatology)

Newborn Screening System Performance Evaluation Assessment Scheme (PEAS)

Seminars in Perinatology — Mon, 08 Mar 2010 17:41:29 +0100

Newborn screening (NBS) reaches approximately all of the 4 million newborns in the United States each year and has been effective in significantly reducing the morbidity and mortality that results from certain congenital conditions. The comprehensive NBS system can be divided into preanalytic (education and screening), analytic (laboratory testing), and postanalytic (reporting, short-term follow-up/tracking, diagnosis, treatment/management, ancillary services, and outcome evaluation) activities. To monitor and improve the screening system, there has been increasing emphasis on evaluation models. Federal sponsorship of a model performance evaluation and assessment scheme (PEAS) has resulted in a comprehensive listing of quality indicators for system self-assessment. We review the PEAS evolu...

Introduction

Seminars in Perinatology — Mon, 08 Mar 2010 17:41:29 +0100

Since the early 1960s, newborn screening (NBS) has been available for comparatively rare congenital conditions that can have devastating effects on newborns and their families. When Bob Guthrie developed his NBS procedure for phenylketonuria, he envisioned a process that would aid in early identification and treatment of conditions that primarily resulted in mental retardation. I am not sure that even he foresaw programs screening for more than 50 conditions by this point; particularly conditions like severe combined immunodeficiency and Krabbe disease—the former in Wisconsin and Massachusetts, and the latter in New York. (Source: Seminars in Perinatology)

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Seminars in Perinatology — Mon, 08 Mar 2010 17:41:29 +0100

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Advanced Neuroimaging Techniques: Their Role in the Development of Future Fetal and Neonatal Neuroprotection

Seminars in Perinatology — Mon, 25 Jan 2010 17:29:34 +0100

This article will provide an overview of normal and abnormal brain development, and explore the role of advanced neuroimaging techniques in neuroprotective therapies in the neonatal intensive care unit. (Source: Seminars in Perinatology)

Brain Plasticity Following Early Life Brain Injury: Insights From Neuroimaging

Seminars in Perinatology — Mon, 25 Jan 2010 17:29:34 +0100

The developing human brain possesses a superior capacity to reorganize after focal lesions. This review describes mechanisms of reorganization following pre- and perinatally-acquired, unilateral brain lesions for motor, somatosensory, and language functions. In the motor system, unilateral damage to the corticospinal tract can lead to the maintenance of normally-transient ipsilateral corticospinal projections from the contralesional hemisphere. In some patients, this type of corticospinal (re)organization can achieve an active grasp function of the paretic hand, while in others no useful hand function develops although such projections exist. In the somatosensory system, periventricular lesions can be compensated by outgrowing thalamocortical projections forming “bypasses” around the d...

The Role of Functional Magnetic Resonance Imaging in the Study of Brain Development, Injury, and Recovery in the Newborn

Seminars in Perinatology — Mon, 25 Jan 2010 17:29:34 +0100

Development of brain functions and the structural-functional correlates of brain injury remain difficult to evaluate in the young infant. Thus, new noninvasive methods capable of early functional diagnosis are needed. This review describes the use of functional magnetic resonance imaging (fMRI) for studying localization of brain function in the developing brain when standard clinical investigations are not available or conclusive. This promising neuroimaging technique has been successfully used in healthy newborns and in newborns with brain injury using different paradigms, including passive visual, somato-sensorial, and auditory stimulation. We summarize the major findings of previous fMRI studies in young infants, describe ongoing methodological challenges, and propose exciting future de...

Magnetic Resonance Imaging of Brain Injury in the High-Risk Term Infant

Seminars in Perinatology — Mon, 25 Jan 2010 17:29:34 +0100

Magnetic resonance imaging (MRI) is noninvasive and nonionizing and offers excellent soft-tissue contrast and good spatial resolution, providing anatomical detail that cannot be obtained by any other imaging modality. In this review, we discuss the imaging findings in perinatal arterial stroke, hypoxic ischemic encephalopathy, metabolic abnormalities, and infection. Conventional imaging can detect patterns of injury that relate to the etiology and timing of an insult and provide valuable information about prognosis. In many cases, diffusion-weighted imaging provides additional information to conventional MRI, and we recommend its use in all clinical MRI investigations. We also consider the utility of tools such as functional MRI, diffusion tensor imaging, and diffusion tractography in the ...

Understanding Brain Injury and Neurodevelopmental Disabilities in the Preterm Infant: The Evolving Role of Advanced Magnetic Resonance Imaging

Seminars in Perinatology — Mon, 25 Jan 2010 17:29:33 +0100

The high incidence of neurodevelopmental disability in premature infants requires continued efforts at understanding the underlying microstructural changes in the brain that cause this perturbation in normal development. Magnetic resonance imaging (MRI) methods offer great potential to fulfill this need. Serial MR imaging and the application of newer analysis techniques, such as diffusion tensor imaging (DTI), volumetric MR analysis, cortical surface analysis, functional connectivity MRI (fcMRI) and diffusion tractography, provide important insights into the trajectory of brain development in the premature infant and the impact of injury on this developmental trajectory. While some of these imaging techniques are currently available in the research setting only, other measures, such as DTI...

Noninvasive Cerebral Perfusion Imaging in High-Risk Neonates

Seminars in Perinatology — Mon, 25 Jan 2010 17:29:33 +0100

Advances in medical and surgical care of the high-risk neonate have led to increased survival. A significant number of these neonates suffer from neurodevelopmental delays and failure in school. The focus of clinical research has shifted to understanding events contributing to neurological morbidity in these patients. Assessing changes in cerebral oxygenation and regulation of cerebral blood flow (CBF) is important in evaluating the status of the central nervous system. Traditional CBF imaging methods fail for both ethical and logistical reasons. Optical near infrared spectroscopy (NIRS) is increasingly being used for bedside monitoring of cerebral oxygenation and blood volume in both very low birth weight infants and neonates with congenital heart disease. Although trends in CBF may be in...

Applications of Positron Emission Tomography in the Newborn Nursery

Seminars in Perinatology — Mon, 25 Jan 2010 17:29:33 +0100

Positron emission tomography (PET) is a relatively noninvasive imaging test that is able to detect abnormalities in different organs based on derangements in the chemical functions and/or receptor expression at the cellular level. PET imaging of the brain has been shown to be a powerful diagnostic tool for detecting neurochemical abnormalities associated with various neurologic disorders as well as to study normal brain development. Although its use in detecting neurological abnormalities has been well described in adults and pediatrics, its application in the newborn nursery has not been explored adequately. Early detection of brain injury secondary to intrauterine and perinatal insults using PET imaging can provide new insight in prognosis and in instituting early therapy. In this review...

Cranial Ultrasonography in Neonates: Role and Limitations

Seminars in Perinatology — Mon, 25 Jan 2010 17:29:33 +0100

In experienced hands, cranial ultrasonography (cUS) is an excellent tool to detect the most frequently occurring brain abnormalities in preterm and full-term neonates, to study the evolution of lesions, and to follow brain maturation. It enables screening of the brain and serial imaging in high-risk neonates. However, cUS also has limitations and magnetic resonance imaging is needed in most neonates with (suspected) parenchymal brain injury and/or neurological symptoms and in very preterm infants. In this review, we discuss the applications, possibilities, indications, predictive value, and limitations of neonatal cUS. We will pay attention to the standard cUS procedure and expand on optimizing the possibilities of cUS by using supplemental acoustic windows and changing transducers and foc...

Magnetic Resonance Spectroscopy Imaging of the Newborn Brain—A Technical Review

Seminars in Perinatology — Mon, 25 Jan 2010 17:29:33 +0100

Magnetic resonance imaging has been widely used noninvasively for pediatric neuroimaging for more than a decade. More recently, with advances in computing, functional techniques for imaging water diffusion, cellular metabolite levels, and blood flow are becoming available. Magnetic resonance spectroscopy imaging (MRSI) offers a snapshot of the metabolic status in the tissue of interest. It is complementary to the more traditionally used anatomic imaging for diagnoses of various abnormalities. This review describes the physical basis of proton MRSI, summarizes currently available techniques and their applications, highlights challenges of performing MRSI in the pediatric population, and previews the newest techniques currently on the horizon. (Source: Seminars in Perinatology)

Basic Principles and Concepts Underlying Recent Advances in Magnetic Resonance Imaging of the Developing Brain

Seminars in Perinatology — Mon, 25 Jan 2010 17:29:33 +0100

This article will review basic principles and concepts underlying recent advances in MR spectroscopy, diffusion, perfusion, and volumetric MR imaging. These techniques provide quantitative assessment and novel insight of both brain development and brain injury in the immature brain. Knowledge of normal developmental changes in quantitative MR values is also essential to interpret pathologic cases. (Source: Seminars in Perinatology)

Introduction

Seminars in Perinatology — Mon, 25 Jan 2010 17:29:33 +0100

Injury to the developing brain is associated with a major risk of debilitating and lifelong developmental disabilities and poor quality of life, which in turn have a potentially enormous impact on the child, family, and society. A significant obstacle to our understanding of neonatal brain injury has been the lack of sensitive and specific markers of imminent cerebral injury. The application of advanced neuroimaging techniques to the newborn emerged in the 1990s, coinciding with the “Decade of the Brain” which was designated to increase awareness of the benefits derived from cutting-edge brain-oriented research. Indeed, the past 2 decades have marked explosive advances in the field of neonatal neuroimaging. These neuroimaging advances have launched a new era of discovery, which has aff...

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Erratum

Seminars in Perinatology — Mon, 16 Nov 2009 16:19:32 +0100

The author listing for the article, “Neurodevelopmental changes of fetal pain,” which was published in Seminars in Perinatology in 2007 (31[5]:275-82), was incomplete. Dr. Barbara Clancy contributed to the article and should have been listed as an author. (Source: Seminars in Perinatology)

Ethics and “Cesarean Delivery on Maternal Demand”

Seminars in Perinatology — Mon, 16 Nov 2009 16:19:32 +0100

There is considerable ongoing debate about whether physicians should supply cesarean delivery to patients purely on the basis of maternal demand. This debate is marred by serious definitional problems. Although planned elective cesareans share a risk-profile with “cesarean delivery on maternal demand,” not every case of planned elective cesarean results from maternal demand. Ethical and practical considerations counsel using language that is more neutral on the question of the reason for, and process of decision-making leading to, cesarean delivery. Consideration of the risks and benefits of planned elective cesarean, coupled with the desirability of a prophylactic rule limiting physicians' offers of elective cesareans, counsels against making routine offers of elective cesareans to pa...

Ethics Education in Neonatal-Perinatal Medicine in the United States

Seminars in Perinatology — Mon, 16 Nov 2009 16:19:31 +0100

Neonatology is one of the specialties that has immensely benefited from advances in medical technology in the last few decades. These advances have paralleled the rise of the civil rights movements and wider recognition of individual rights. As a result, ethical decision-making has become more complex, involving patients, parents, members of the health care team, and society in general. This has created a need for formal ethics education in neonatal-perinatal medicine fellowship programs. In this article, we briefly explore the current published data on ethics education in pediatric residency and neonatal-perinatal medicine fellowship programs. Then, we discuss the questions an academic educator may face while developing an ethics curriculum in his/her medical institution. Finally, we pres...

Ethics of Research in Perinatal Medicine

Seminars in Perinatology — Mon, 16 Nov 2009 16:19:31 +0100

Ethics is an essential component of fetal research. From definitions of medical ethics and the ethical principles of beneficence and respect for autonomy, we identify the ethical concept of the fetus as a patient. We then identify major components of research ethics. On these 2 bases, we identify ethically justified criteria for initiating study of innovative fetal interventions, for randomized trials in fetal research, for making the clinical, scientific, and ethical judgment that fetal research has produced a new standard of care, and for stopping rules for fetal research. (Source: Seminars in Perinatology)

The Texas Advance Directives Act—Is It a Good Model?

Seminars in Perinatology — Mon, 16 Nov 2009 16:19:31 +0100

The Texas Advance Directives Act was first passed in 1999 to help resolve conflicts between families and physicians when disagreements exist over continuing or halting treatments of patients. When the physician feels that continued treatment is ethically or morally unjustified and seeks to end life support for a patient against the wishes of the family, it establishes a specific path that must be followed to afford legal protection to the physician and institution. Its proponents believe that it reduces morally unjustifiable treatment of terminal patients, while its opponents argue that it places too much power in the hands of physicians and institutions. This review analyzes both sides of the argument, gives 2 examples of its application, and concludes that it is a good model but requires...

Neonatal Euthanasia

Seminars in Perinatology — Mon, 16 Nov 2009 16:19:31 +0100

Despite advances in the care of infants, there remain many newborns whose medical conditions are incompatible with sustained life. At times, healthcare providers and parents may agree that prolonging life is not an appropriate goal of care, and they may redirect treatment to alleviate suffering. While pediatric palliative treatment protocols are gaining greater acceptance, there remain some children whose suffering is unrelenting despite maximal efforts. Due to the realization that some infants suffer unbearably (ie, the burdens of suffering outweigh the benefits of life), the Dutch have developed a protocol for euthanizing these newborns. In this review, I examine the ethical aspects of 6 forms of end of life care, explain the ethical arguments in support of euthanasia, review the history...

Disputes Over Moral Standards Guiding Treatments for Imperiled Infants

Seminars in Perinatology — Mon, 16 Nov 2009 16:19:31 +0100

Two incompatible policies govern medical decision-making for infants aged < 1 year in the United States. One is the Best Interests Standard, which is the older policy, and the other is the Child Abuse Prevention and Treatment Act amendments widely known as the “Baby Doe” rules. The debate over which policy to adopt, however, is more far-reaching than treatment for one group in one country as it involves how to rank important medical values when they come into conflict. These are the values of prolonging biological life and of providing comfort and relief from pain and suffering for imperiled and incompetent persons. For reasons of justice and compassion, the Best Interests Standard is superior to Child Abuse Prevention and Treatment Act's Baby Doe Rules for guiding decision for infants...

Ethical Issues in Research Involving Infants

Seminars in Perinatology — Mon, 16 Nov 2009 16:19:31 +0100

The future health of infants and children is dependent on the performance of clinical research in which infants participate. Achieving a proper balance between this social good and the obligation to protect infants who participate in research is a significant challenge. As investigators design and implement research protocols, they should be aware of the ethical and legal requirements that govern research with infants. For research to satisfy ethical and legal requirements it must be scientifically sound and significant, subject selection must be fair, approaching families for enrollment must avoid pressure, the risks to participants cannot be excessive and must be minimized, risks must be justified by the benefits of the research, valid and voluntary informed consent must be obtained, enr...

The Ethics of Newborn Resuscitation

Seminars in Perinatology — Mon, 16 Nov 2009 16:19:31 +0100

It is widely believed in neonatology and obstetrics that there are situations in which it is inappropriate to attempt newborn resuscitation, and other times when newborn resuscitation is obligatory despite parental refusal. In each case, an ethical justification for the decision needs to be identified. This essay is intended to provide guidance in deciding when resuscitation should be attempted, and in identifying ethical considerations that should be taken into account. It specifically addresses the issue of extreme prematurity, including an analysis of current recommendations, the data, relevant rights of patient and parents, and a discussion of the relative merits of withholding resuscitation vs providing resuscitation and possibly withdrawing intensive care later. In addition to extrem...

Introduction: Taking the Time for Medical Ethics

Seminars in Perinatology — Mon, 16 Nov 2009 16:19:31 +0100

In considering our approach to ethical problems in medicine, a good place to start is our approach to other decisions in this same arena. Most decisions that we face in the clinical setting are addressed based on some combination of personal experience, education, professional guidelines, standard of care, understanding of physiology, and scientific evidence. The ongoing emphasis on evidence-based medicine, however, rightly suggests that these factors should not be given equal weight. That is, good clinical trials should count for more than personal opinion, or how one was trained years ago. Moreover, if there is a clinical approach widely or even universally accepted within the profession that is clearly inconsistent with good data, the approach should be re-examined, and should likely be...

Seminars in Perinatology — Mon, 16 Nov 2009 16:19:31 +0100

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Prevention of Preterm Birth Based on Short Cervix: Symptomatic Women With Preterm Labor or Premature Prelabor Rupture of Membranes

Seminars in Perinatology — Wed, 30 Sep 2009 18:22:59 +0100

The diagnosis of preterm labor (PTL) is challenging, especially in women whose cervical dilatation is (Source: Seminars in Perinatology)

Alternative Treatment for a Short Cervix: The Cervical Pessary

Seminars in Perinatology — Wed, 30 Sep 2009 18:22:59 +0100

Preterm birth is the leading cause of perinatal morbidity and mortality in the United States. The risk of preterm birth is inversely proportional to the length of the cervix on transvaginal sonography. The traditional treatment for a short cervix has been cerclage and recently there are newer trials using progesterone for this same indication. This manuscript reviews the published data regarding the use of an old method for the treatment of cervical insufficiency, “The Cervical Pessary.” A MEDLINE search was performed and articles published since 1959 regarding the use of pessary for cervical insufficiency were identified and reviewed. The pessary may represent an easy and safe intervention in the treatment of a short cervix diagnosed in the midtrimester. Further research is merited to...

Prevention of Preterm Birth Based on Short Cervix: Progesterone

Seminars in Perinatology — Wed, 30 Sep 2009 18:22:59 +0100

Preterm delivery, which occurs in about 5%-13% of pregnancies in most countries, is the main cause of neonatal morbidity and mortality. Symptomatic treatment of pregnancies presenting in preterm labor with corticosteroids has improved perinatal outcome but has not reduced the incidence of preterm delivery. Recent evidence suggests that the rate of preterm delivery may be reduced by the prophylactic use of progesterone in women with a history of preterm delivery and in those with a short cervical length identified by routine transvaginal sonography. This review summarizes the evidence (level A evidence) of the effectiveness of progesterone on the rate of preterm birth. (Source: Seminars in Perinatology)

Prevention of Preterm Birth Based on a Short Cervix: Cerclage

Seminars in Perinatology — Wed, 30 Sep 2009 18:22:59 +0100

In an attempt to prevent preterm birth, clinicians have recommended cerclage for women with shortened cervical length and other worrisome sonographic cervical features in the mid-trimester, although randomized trials have not supported this practice. Emerging data suggest that preterm birth is a complex and poorly understood syndrome comprising several anatomic and functional components. As a result, preventive efforts have been mostly empiric and generally ineffective. Plausibly, effective preterm birth therapies exist, but matching the effective treatment with the correct patient has been problematic. Mid-trimester cervical changes visualized with vaginal sonography likely represent a pathologic process of premature cervical ripening and not real mechanical disability which has been trad...

Prediction of Preterm Birth: Cervical Sonography

Seminars in Perinatology — Wed, 30 Sep 2009 18:22:59 +0100

The cervix has to open to allow vaginal birth. Ultrasound has now shown that this lower part of the uterus begins to show changes weeks before eventual birth. Only transvaginal ultrasound should be used to evaluate the cervix for prediction of preterm birth (PTB). The shortest best cervical length (CL) is the most effective measurement for clinical use. Proper technique is paramount for accurate results. The risk of PTB increases with ever shorter CL ( (Source: Seminars in Perinatology)

Prediction of Preterm Birth: Nonsonographic Cervical Methods

Seminars in Perinatology — Wed, 30 Sep 2009 18:22:59 +0100

A short cervix in the second trimester is a powerful predictor of preterm birth risk. Multiple cervical length screens for patients in midpregnancy will likely become the standard of obstetrical care as a result of the development of effective methods (eg, cerclage, progesterone) to prevent early delivery in patients with a short cervix. Because of the high cost and infrastructure requirements, providing multiple cervical length evaluations through transvaginal ultrasound will likely be a significant barrier to universal screening. A cost-effective, low-technology method of cervical length screening is necessary to implement such programs. Available data suggest that digital examination is not sufficiently sensitive and reproducible to reliably screen for short cervix in presymptomatic pat...

Genetics of the Cervix in Relation to Preterm Birth

Seminars in Perinatology — Wed, 30 Sep 2009 18:22:59 +0100

Preterm birth is the most significant problem encountered in obstetrics in the developed world. Genetic factors are thought to play a role in a proportion of preterm births, and candidate genes have been studied in several areas relevant to parturition. Abnormal cervical function, a clinical spectrum, including cervical insufficiency (CI), is a contributing factor to the overall problem of preterm birth. There are many risk factors and etiologies for CI. However, it is becoming clear that, at least in part, a genetic predisposition to CI plays a role in the condition. Specifically, genes related to connective tissue metabolism and inflammation have been shown to be associated with CI. (Source: Seminars in Perinatology)

Relationships Between Mechanical Properties and Extracellular Matrix Constituents of the Cervical Stroma During Pregnancy

Seminars in Perinatology — Wed, 30 Sep 2009 18:22:59 +0100

The objective of this review is to discuss relationships between biochemical constituents and macroscopic mechanical properties. The individual constituents of the ECM will be discussed, especially in regard to collagen remodeling during pregnancy. In addition, the macroscopic mechanical properties of cervical tissue will be reviewed. An improved understanding of the biochemistry of cervical “strength” will shed light on how the cervix maintains its shape in normal pregnancy and shortens in preterm birth. (Source: Seminars in Perinatology)

Introduction

Seminars in Perinatology — Wed, 30 Sep 2009 18:22:59 +0100

I thank Drs D'Alton and Gross for providing me with the opportunity to edit this issue of Seminars in Perinatology. It is an honor. Preterm birth remains the biggest reason for perinatal morbidity and mortality. It occurs in over 500,000 women every year in the United States, accounting for almost 13% of total births. Many of these preterm neonates either die or suffer, at times for life, of the complications of being born too early. The Center for Disease Control has calculated that, in years-of-life-lost, preterm birth is the biggest killer among any other conditions, including heart disease or cancer. In fact, for the most part, they are the normal fetuses that come under grave danger by being born before they reach full maturity. (Source: Seminars in Perinatology)

Topics for 2008

Seminars in Perinatology — Wed, 30 Sep 2009 18:22:59 +0100

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Seminars in Perinatology — Wed, 30 Sep 2009 18:22:59 +0100

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Advancing Fetal Brain MRI: Targets for the Future

Seminars in Perinatology — Fri, 24 Jul 2009 12:12:53 +0100

Fetal MRI is becoming an increasingly powerful imaging tool for studying brain development in vivo. Until recently, the application of advanced magnetic resonance imaging techniques was limited by motion in the nonsedated fetus. Extensive research efforts currently underway are focusing on the development of dedicated magnetic resonance imaging sequences and sophisticated postprocessing techniques that are revolutionizing our ability to study the healthy and compromised fetus. The ongoing refinement of these magnetic resonance imaging techniques will undoubtedly lead to the development of cornerstone biomarkers that will provide healthcare caregivers with vital, and currently lacking, information upon which to counsel parents effectively, and base rational decisions regarding the timing an...

The Emerging Role of Functional MRI for Evaluating Fetal Brain Activity

Seminars in Perinatology — Fri, 24 Jul 2009 12:12:53 +0100

Although functional magnetic resonance imaging is a technique that is widely used in adult populations, its use within a fetal environment has been extremely limited. Problems associated with movement and technical scanning issues have limited its effectiveness in providing reliable and spatially accurate details of fetal brain activity. However, initial research has indicated that it is a viable tool for assessing functional maturation in the fetus, and recent advances in echo-planar imaging sequences on the abdomen at 3-T provide the potential for more reliable activation detection and higher resolution spatial information. If the technique can be further developed such that a similar reliability in activity patterns is observed as in conventional functional MRI, then fetal functional MR...

Placental Morphologic and Functional Imaging in High-Risk Pregnancies

Seminars in Perinatology — Fri, 24 Jul 2009 12:12:53 +0100

The placenta is vital for fetal growth and development. Improvement in ultrasound and magnetic resonance imaging have improved our understanding of placental morphology that can be important as in the case of placental accrete/percreta. Functional imaging is presently mainly performed by the use of Doppler ultrasound and can give information on placental perfusion, which can be vital for clinical diagnosis. This review summarizes the present knowledge on placental imaging and it's clinical value in high-risk pregnancies. (Source: Seminars in Perinatology)

Evaluation of Fetal Cerebrovascular Circulation and Brain Development: The Role of Ultrasound and Doppler

Seminars in Perinatology — Fri, 24 Jul 2009 12:12:53 +0100

The human fetal brain is protected from pressure changes by autoregulation of the cerebral circulation. However, antenatal intrauterine cerebrovascular events are found to play an important role in the pathogenesis of perinatal brain damage. Changes in placental vascular resistance, cardiac contractibility, vessel compliance, and blood viscosity alter the normal dynamics of fetal cerebral circulation. The introduction of various sonographic techniques and the collection of data from the arterial and venous cerebral circulation provide a powerful tool for the evaluation of physiological and pathological hemodynamic events. Anatomic and physiological considerations of cerebral vasculature in healthy and disease states are relevant in studying brain development and variations in fetal brain b...

Diagnostic Pitfalls in Fetal Brain MRI

Seminars in Perinatology — Fri, 24 Jul 2009 12:12:53 +0100

Recent technological advances in fetal magnetic resonance imaging (MRI) and increased reliability of MRI in depicting abnormalities and lesions, especially in the central nervous system, are increasingly bringing up challenging issues with regard to accurate diagnosis. There are also pitfalls not only attributable to image acquisition but also in clinical interpretation. The misinterpretation of findings because of insufficient knowledge about fetal brain development as visualized by MRI may also be regarded as an important limitation of fetal MRI. We provide an overview of the most common pitfalls experienced in fetal MRI in routine practice, demonstrate how to identify some of the factors that lead to imaging misinterpretation, and suggest ways to tackle these problems, with an emphasis ...

Fetal Magnetic Resonance Imaging of Acquired and Developmental Brain Anomalies

Seminars in Perinatology — Fri, 24 Jul 2009 12:12:53 +0100

During the last decade, increasing interest in magnetic resonance imaging has emerged for the evaluation of fetal abnormalities detected on ultrasound. The advent of single-shot rapid acquisition sequences has greatly facilitated our ability to obtain detailed imaging information of the fetal brain. To date, fetal magnetic resonance imaging has shown to have an important role in the investigation of cerebral abnormalities suspected by sonography, and in the detection of subtle brain anomalies associated with high-risk pregnancies. Magnetic resonance imaging has proved to be a useful adjunct to sonography during the prenatal period of development, especially for the detection of acquired disorders. (Source: Seminars in Perinatology)

Insights From In Vitro Fetal Magnetic Resonance Imaging of Cerebral Development

Seminars in Perinatology — Fri, 24 Jul 2009 12:12:51 +0100

The development of the cerebral cortex, white matter microstructure, and the basal ganglia can be well characterized using structural magnetic resonance imaging (MRI). In this review, we analyzed structural in vitro MRI studies of transient cellular cerebral zones that are sites of neurogenetic events (proliferation, migration, cell aggregation, growth of axonal pathways, myelinization, and synaptogenesis). During early fetal life, from 9-13 postconceptional weeks, a thick, densely packed cellular ventricular/subventricular zone and ganglionic eminence indicate intensive proliferation of neuroepithelial stem cells. During the mid and late fetal phase, other cellular zones also became discernable: (1) the intermediate zone as a migratory and axonal growth zone; (2) the subplate zone as a sy...

Normal Development of the Fetal Brain by MRI

Seminars in Perinatology — Fri, 24 Jul 2009 12:12:51 +0100

This article will review techniques of fetal MRI as well as several key aspects of brain development and their appearance on MRI. An understanding of normal fetal brain development is essential to correctly identifying developmental abnormalities. (Source: Seminars in Perinatology)

Introduction

Seminars in Perinatology — Fri, 24 Jul 2009 12:12:51 +0100

This issue of Seminars in Perinatology is devoted to fetal neuroimaging. During the last decade, significant advances have been made in the care of the developing brain. However, our understanding of the dynamic and elaborate development of the central nervous system in utero had been impeded by a lack of reliable and clinically applicable neuroimaging benchmarks. The selected topics addressed in this issue illustrate how recent advances in neuroimaging techniques are providing us with the unprecedented opportunity to study, in intricate detail, the developing nervous system of the healthy and compromised fetus. (Source: Seminars in Perinatology)

Topics for 2008

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Erratum

Seminars in Perinatology — Sun, 24 May 2009 21:14:42 +0100

Seminars in Perinatology has made a minor revision in editorial policy. The contact information for guest editors will now appear in the Introduction to the issue. Dr. Edmund F. La Gamma's contact information was not included in the November-December 2008 entitled “Transient Hypothyroximemia of Prematurity” (Volume 32, Number 6, pages 377-446); it is provided below: (Source: Seminars in Perinatology)

Imitators of Severe Pre-eclampsia

Seminars in Perinatology — Sun, 24 May 2009 21:14:12 +0100

There are many obstetric, medial, and surgical disorders that share many of the clinical and laboratory findings of patients with severe pre-eclampsia–eclampsia. Imitators of severe pre-eclampsia–eclampsia are life-threatening emergencies that can develop during pregnancy or in the postpartum period. These conditions are associated with high maternal and perinatal mortalities and morbidities, and survivors may face long-term sequelae. The pathophysiologic abnormalities in many of these disorders include vasospasm, platelet activation or destruction, microvascular thrombosis, endothelial cell dysfunction, and reduced tissue perfusion. Some of these disorders include acute fatty liver of pregnancy, thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, acute exacerbation of syst...

Abruptio Placentae and Disseminated Intravascular Coagulopathy

Seminars in Perinatology — Sun, 24 May 2009 21:13:45 +0100

Abruptio placentae is an important cause of vaginal bleeding in the latter half of pregnancy. The key factor in the pathophysiology is hemorrhage at the decidual–placental interface. Small episodes may escape clinical detection, but severe grades impact significantly on fetal and maternal morbidity and mortality, with the most frequent complications being fetal death, severe maternal shock, disseminated intravascular coagulopathy, and renal failure. Important risk factors for the development of abruptio placentae are previous abruption, hypertensive diseases, abdominal trauma, growth restriction, and smoking. The diagnosis is essentially made on the clinical picture that includes vaginal bleeding (usually dark blood), abdominal pain, and uterine contractions. The essence of management is...

Gastrointestinal Complications of Pre-eclampsia

Seminars in Perinatology — Sun, 24 May 2009 21:12:46 +0100

Gastrointestinal complications of pre-eclampsia can occur and have the risk of being life-threatening for the mother and fetus. Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome has been recognized as a complication of pre-eclampsia for decades. Pregnancies complicated by this syndrome require a well-formulated management plan, including assessing and stabilizing the maternal condition as well as evaluating fetal well-being. Patients with HELLP syndrome should receive anti-seizure prophylaxis with magnesium sulfate, treatment for severe hypertension, and correction of coagulopathy, if present. The potential benefits of expectant management of HELLP syndrome in those remote from term and the use of corticosteroids to improve maternal outcome remain experimental. Computed...

Pre-eclampsia and the Kidney

Seminars in Perinatology — Sun, 24 May 2009 21:11:55 +0100

Pre-eclampsia is a multisystem disorder that is unique to pregnancy, affecting at least 5% of all gravidas. The mainstay of this diagnosis is a combination of new-onset hypertension and proteinuria. The kidney deserves particular attention because of the physiologic as well as pathologic changes that can affect this vital organ in pregnancy. In fact, there is a major interplay between renal disease and pre-eclampsia. Proteinuria is universal to all cases of pre-eclampsia, yet some cases can progress to acute renal failure. Furthermore, it is well-established that the latter is more frequent in women with underlying renal disease. This chapter reviews the physiologic changes that the human kidney adapts during pregnancy, the impact of pre-eclampsia on the kidney and its function, and the ri...

Neurologic Complications of Pre-eclampsia

Seminars in Perinatology — Sun, 24 May 2009 21:11:25 +0100

Pre-eclampsia is mainly responsible for the world's large maternal mortality rates, mostly due to acute cerebral complications. This review provides insight into the pathogenesis of the neurologic complications of hypertensive disease in pregnancy. In addition, practical relevance for clinical care is highlighted. Pertaining to pregnancy, the blood pressure level at which cerebral autoregulation operates and possible deregulation occurs is unknown, but is likely to be variable. From clinical observation, eclampsia may occur despite a mild clinical picture and before the development of hypertension or proteinuria. Furthermore, failure of cerebrovascular autoregulatory mechanisms in response to either an acute and/or relatively large blood pressure increase may be more important than the abs...

Cardiopulmonary Complications of Pre-eclampsia

Seminars in Perinatology — Sun, 24 May 2009 21:10:56 +0100

This article aims to review complications of pre-eclampsia as they impact on the cardiovascular and pulmonary systems. (Source: Seminars in Perinatology)

Predicting Adverse Outcomes in Women with Severe Pre-eclampsia

Seminars in Perinatology — Sun, 24 May 2009 21:10:27 +0100

The reason pre-eclampsia matters so much to maternity care providers is that adverse maternal and perinatal events cluster around the diagnosis of proteinuric gestational hypertension. While that is true, most pre-eclampsia is mild and evanescent, resolving rapidly postpartum. Therefore, every effort must be made to identify those women at greatest personal risk, and those bearing fetuses at greatest risk, so that they can be offered closer surveillance and lower thresholds for the use of effective interventions, such as delivery and the use of MgSO4. Conversely, as delivery remote from term can increase perinatal risks and as liberal MgSO4 use is associated with maternal morbidity, it may be as important to identify those women who have “mild” disease and bear little personal and/or f...

Expectant Management in Pregnancies with Severe Pre-eclampsia

Seminars in Perinatology — Sun, 24 May 2009 21:10:18 +0100

The main objective of expectant management in women with severe pre-eclampsia (PE) remote from term is to improve neonatal outcome. Maternal conditions, however, may worsen during expectant management. This highlights the importance of balancing the risks between maternal and perinatal outcomes. Traditionally, women with severe PE remote from term are delivered expeditiously, regardless of gestational age. We here have reported several retrospective, case-control, observational, prospective, or randomized trials in which expectant management in women with severe PE was feasible in well-selected patients without prejudicing maternal safety, and we have described our rationale and guidelines for this management. (Source: Seminars in Perinatology)

The Management of Severe Hypertension

Seminars in Perinatology — Sun, 24 May 2009 21:09:53 +0100

Although definitions of severe hypertension vary, thresholds of ≥160-170 mm Hg systolic and/or ≥110 mm Hg diastolic are in most common usage. A recent focus has been placed on systolic hypertension given the increased pulse pressure in these women. In pregnancy, there is a general consensus that severe hypertension should be treated. Among woman with pre-eclampsia, attention must be paid to other end organ dysfunction, as blood pressure (BP) management is but one aspect of care. The urgency of antihypertensive therapy will depend primarily on the absolute level of BP. However, most clinicians will also consider both the rate of BP rise and the presence of maternal symptoms. Most commonly, severe hypertension is treated with parenteral labetalol or hydralazine, or oral nifedipine (capsu...

The Global Impact of Pre-eclampsia and Eclampsia

Seminars in Perinatology — Sun, 24 May 2009 21:09:05 +0100

Over half a million women die each year from pregnancy related causes, 99% in low and middle income countries. In many low income countries, complications of pregnancy and childbirth are the leading cause of death amongst women of reproductive years. The Millennium Development Goals have placed maternal health at the core of the struggle against poverty and inequality, as a matter of human rights. Ten percent of women have high blood pressure during pregnancy, and preeclampsia complicates 2% to 8% of pregnancies. Preeclampsia can lead to problems in the liver, kidneys, brain and the clotting system. Risks for the baby include poor growth and prematurity. Although outcome is often good, preeclampsia can be devastating and life threatening. Overall, 10% to 15% of direct maternal deaths are a...

Introduction

Seminars in Perinatology — Sun, 24 May 2009 21:08:25 +0100

Throughout the world, millions of women develop preeclampsia each year. Many of these women will deliver healthy infants at term and recover without serious long-term sequelae. Others will suffer morbidity and mortality associated with this complex multisystem disease, which may result in perinatal death and severe maternal and neonatal disability. In the developing world, women who do not have access to magnesium therapy despite its low cost and proven effectiveness remain at significant risk to develop eclampsia and its associated complications. (Source: Seminars in Perinatology)

Topics for 2008

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Transfusion Therapy in Postpartum Hemorrhage

Seminars in Perinatology — Wed, 01 Apr 2009 04:00:00 +0100

Postpartum hemorrhage (PPH) is an obstetric emergency that can occur following vaginal or cesarean delivery. Rapid diagnosis of PPH using laboratory and clinical parameters is an important first step in its management. Traditional blood components, including packed red blood cells, platelets, plasma, and cryoprecipitate, should be used in patients with significant bleeding. Recent studies underline the utility of transfusing these components in defined ratios to prevent dilutional coagulopathy. Disseminated intravascular coagulation (DIC) should be considered in severely bleeding obstetric patients and should be treated aggressively using blood components. Newer hemostatic agents, such as activated factor VII, will play significant roles in patients with bleeding that is refractory to stan...

The Role of the Anesthesiologist in Management of Obstetric Hemorrhage

Seminars in Perinatology — Wed, 01 Apr 2009 04:00:00 +0100

Hemorrhage after childbirth, whether the delivery is vaginal or operative, is a clinical situation where knowledge, communication, and the availability and utilization of resources all play prominent roles. In this article we describe the thought processes and decisions that should occur, and the actions that should be taken by the anesthesiologist in the face of suspected, expected, or unexpected hemorrhage in the labor and delivery suite. (Source: Seminars in Perinatology)

Surgical Intervention in the Management of Postpartum Hemorrhage

Seminars in Perinatology — Wed, 01 Apr 2009 04:00:00 +0100

Obstetric hemorrhage is often a sudden, life-threatening event. Successful management hinges on both preoperative preparation if hemorrhage is anticipated as well as knowledge of interventions. Uterine-sparing techniques, such as aggressive and early use of uterotonics, balloon tamponade, uterine compression sutures, arterial ligation, and selective arterial embolization, may be used to control hemorrhage. If these techniques are not adequate, the decision must be made to proceed with hysterectomy. The type of hysterectomy (subtotal vs. total) must be individualized to each patient. Hemostatic agents may be particularly useful in patients who have excessive blood loss from raw tissue surfaces. (Source: Seminars in Perinatology)

Optimizing Outcomes Through Protocols, Multidisciplinary Drills, and Simulation

Seminars in Perinatology — Wed, 01 Apr 2009 04:00:00 +0100

Delay in diagnosis, failure to employ sufficient medical and surgical treatments, and poor teamwork all may contribute to suboptimal outcomes in cases of postpartum hemorrhage. A significant portion of hemorrhage-related maternal morbidity may be prevented through early diagnosis and rapid intervention. There is a small but growing body of literature describing the role of patient safety initiatives and simulation training in optimizing outcomes following postpartum hemorrhage. Rapid response teams may be used to facilitate coordination between various personnel involved in the management of postpartum hemorrhage. Hemorrhage drills and simulation-based training may help providers achieve timely and coordinated responses in the treatment of postpartum hemorrhage. Protocol may help to standa...

Obstetric Emergencies

Seminars in Perinatology — Wed, 01 Apr 2009 04:00:00 +0100

Uterine rupture, uterine inversion, and pelvic lacerations/hematomas are all associated with increased risk for hemorrhage at the time of delivery. Certain clinical factors will increase the likelihood that these complications will occur, and clinical management can be adapted to reduce risk. Prior cesarean section is a significant risk factor for uterine rupture, with the degree of risk directly related to the location and quantity of prior uterine incisions. Obstetric trauma is another independent risk factor for uterine rupture. In turn, uterine inversion has traditionally been associated with overly aggressive management of the third stage of labor. The forces of normal labor and delivery will sometimes result in lacerations and hematomas of the lower genital tract. Except for the most...

Abnormal Placentation

Seminars in Perinatology — Wed, 01 Apr 2009 04:00:00 +0100

Abnormal placentation poses a diagnostic and treatment challenge for all providers caring for pregnant women. As one of the leading causes of postpartum hemorrhage, abnormal placentation involves the attachment of placental villi directly to the myometrium with potentially deeper invasion into the uterine wall or surrounding organs. Surgical procedures that disrupt the integrity of uterus, including cesarean section, dilatation and curettage, and myomectomy, have been implicated as key risk factors for placenta accreta. The diagnosis is typically made by gray-scale ultrasound and confirmed with magnetic resonance imaging, which may better delineate the extent of placental invasion. It is critical to make the diagnosis before delivery because preoperative planning can significantly decrease...

Uterine Atony: Definition, Prevention, Nonsurgical Management, and Uterine Tamponade

Seminars in Perinatology — Wed, 01 Apr 2009 04:00:00 +0100

Uterine atony, or failure of the uterus to contract following delivery, is the most common cause of postpartum hemorrhage. This review serves to examine the prevention and treatment of uterine atony, including risk-factor recognition and active management of the third stage of labor. A range of uterotonic agents will be compared for efficacy, safety, and ease of administration. Oxytocin and ergot alkaloids represent the cornerstone of uterotonic therapy, while prostaglandin therapy has been studied more recently as an attractive alternative, particularly for resource-poor settings. Newer supplementary medical therapies, such as recombinant factor VII and hemostatic agents, and adjunctive nonsurgical methods aimed at achieving uterine tamponade will be evaluated. (Source: Seminars in Perina...

Obstetric Hemorrhage

Seminars in Perinatology — Wed, 01 Apr 2009 04:00:00 +0100

Despite advances is medical and surgical therapy, obstetric hemorrhage remains a significant medical problem for both the developing and developed world. Depending on the definition that is used, postpartum hemorrhage complicates up to 18% of all deliveries. It is the single most important cause of maternal mortality worldwide, accounting for 25% to 30% of all maternal deaths, and it is the most common maternal morbidity in the developed world. Most cases of hemorrhage are related to uterine atony and abnormal placentation; however, many patients have no identifiable risk factors. Implementation of the active management of labor has resulted in a significant reduction in the incidence postpartum hemorrhage. However, a large number of cases still involve suboptimal care, with delays in diag...

Introduction

Seminars in Perinatology — Wed, 01 Apr 2009 04:00:00 +0100

It is a widely accepted sentiment that “it takes a village to raise a child.” It may be just as appropriate to state that it takes a team to deliver a baby. This may be most appropriate when reviewing the management of obstetric hemorrhage. In this issue of Seminars in Perinatology, we will present a clinical review of obstetric hemorrhage. This review will include a discussion of management options, many of which are focused on preparedness and team development. (Source: Seminars in Perinatology)

Topics for 2008

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The Evolution of Early Hearing Detection and Intervention Programs in the United States

Digital Microfluidics: A Future Technology in the Newborn Screening Laboratory?

Enhancing the Quality and Efficiency of Newborn Screening Programs Through the Use of Health Information Technology

Newborn Screening Progress in Developing Countries—Overcoming Internal Barriers

History and Current Status of Newborn Screening for Hemoglobinopathies

Improving and Assuring Newborn Screening Laboratory Quality Worldwide: 30-Year Experience at the Centers for Disease Control and Prevention

From Developing Guidelines to Implementing Legislation: Actions of the US Advisory Committee on Heritable Disorders in Newborns and Children Toward Advancing and Improving Newborn Screening

Newborn Screening System Performance Evaluation Assessment Scheme (PEAS)

Introduction

Topics for 2009

Table of Contents

Masthead

Cover

Advanced Neuroimaging Techniques: Their Role in the Development of Future Fetal and Neonatal Neuroprotection

Brain Plasticity Following Early Life Brain Injury: Insights From Neuroimaging

The Role of Functional Magnetic Resonance Imaging in the Study of Brain Development, Injury, and Recovery in the Newborn

Magnetic Resonance Imaging of Brain Injury in the High-Risk Term Infant

Understanding Brain Injury and Neurodevelopmental Disabilities in the Preterm Infant: The Evolving Role of Advanced Magnetic Resonance Imaging

Noninvasive Cerebral Perfusion Imaging in High-Risk Neonates

Applications of Positron Emission Tomography in the Newborn Nursery

Cranial Ultrasonography in Neonates: Role and Limitations

Magnetic Resonance Spectroscopy Imaging of the Newborn Brain—A Technical Review

Basic Principles and Concepts Underlying Recent Advances in Magnetic Resonance Imaging of the Developing Brain

Introduction

Topics for 2009

Table of Contents

Masthead

Cover

Erratum

Ethics and “Cesarean Delivery on Maternal Demand”

Ethics Education in Neonatal-Perinatal Medicine in the United States

Ethics of Research in Perinatal Medicine

The Texas Advance Directives Act—Is It a Good Model?

Neonatal Euthanasia

Disputes Over Moral Standards Guiding Treatments for Imperiled Infants

Ethical Issues in Research Involving Infants

The Ethics of Newborn Resuscitation

Introduction: Taking the Time for Medical Ethics

Table of Contents

Topics for 2008

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Prevention of Preterm Birth Based on Short Cervix: Symptomatic Women With Preterm Labor or Premature Prelabor Rupture of Membranes

Alternative Treatment for a Short Cervix: The Cervical Pessary

Prevention of Preterm Birth Based on Short Cervix: Progesterone

Prevention of Preterm Birth Based on a Short Cervix: Cerclage

Prediction of Preterm Birth: Cervical Sonography

Prediction of Preterm Birth: Nonsonographic Cervical Methods

Genetics of the Cervix in Relation to Preterm Birth

Relationships Between Mechanical Properties and Extracellular Matrix Constituents of the Cervical Stroma During Pregnancy

Introduction

Topics for 2008

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Advancing Fetal Brain MRI: Targets for the Future

The Emerging Role of Functional MRI for Evaluating Fetal Brain Activity

Placental Morphologic and Functional Imaging in High-Risk Pregnancies

Evaluation of Fetal Cerebrovascular Circulation and Brain Development: The Role of Ultrasound and Doppler

Diagnostic Pitfalls in Fetal Brain MRI

Fetal Magnetic Resonance Imaging of Acquired and Developmental Brain Anomalies

Insights From In Vitro Fetal Magnetic Resonance Imaging of Cerebral Development

Normal Development of the Fetal Brain by MRI

Introduction

Topics for 2008

Table of Contents

Masthead

Cover

Erratum

Imitators of Severe Pre-eclampsia

Abruptio Placentae and Disseminated Intravascular Coagulopathy

Gastrointestinal Complications of Pre-eclampsia

Pre-eclampsia and the Kidney

Neurologic Complications of Pre-eclampsia

Cardiopulmonary Complications of Pre-eclampsia

Predicting Adverse Outcomes in Women with Severe Pre-eclampsia

Expectant Management in Pregnancies with Severe Pre-eclampsia

The Management of Severe Hypertension

The Global Impact of Pre-eclampsia and Eclampsia