Key Points The main objective of routine midtrimester ultrasonography (US) is to provide accurate diagnostic information for the delivery of optimised antenatal care, including delivery planning. Routine early US is beneficial because of better estimates of gestational age. Routine US…
Key Points Early diagnosis of structural anomalies is increasingly possible. About half of the congenital anomalies can be diagnosed in the late first trimester. Severe and often lethal anomalies can be diagnosed, allowing parents the options of continuing with the…
Key Points First trimester screening for Down syndrome (DS) with a combination of ultrasound, nuchal translucency and two maternal serum markers (combined test) has a much better performance than second trimester screening with four serum markers (quad test). Combined test…
Key Points Good practice in information giving is essential as choosing to have a prenatal screening test can have far-reaching consequences. To be of good quality, information must be up to date and evidence-based. It should as a minimum include…
Key Points Screening is the identification of unrecognised disease or defect found by testing an asymptomatic population. Prenatal screening detects conditions that are deleterious to the mother, fetus or both. Prenatal screening allows for diagnostic testing and subsequent pregnancy options,…
Key Points A fetus can be treated but is not a patient in the normative sense of the term. Because a fetus can only be treated via the body of a pregnant woman, fetal treatment always makes her a patient…
Key Points The randomised controlled trial (RCT) is the least biased method of assessing the effectiveness of clinical interventions. It has been little used in fetal medicine, but reports are increasing. The details of good clinical trial methodology are now…
Key Points Perinatal autopsy (examination after death) fulfils several roles, including determination or clarification of the underlying diagnosis, answering specific questions raised by parents and clinicians, quality assurance, governance and public health aspects, and improved understanding of disease mechanisms through…
Key Points Development of the kidneys (nephrogenesis) occurs between the 5th and 32nd weeks of human gestation when the ureteric bud interacts with metanephric mesenchyme, which undergoes mesenchymal–epithelial conversion to form glomeruli and tubules and renal stroma, with coordinated vascular…
Key Points Survival at birth depends upon the lung attaining an adequate size and degree of structural maturity during fetal life. This chapter deals with mechanisms underlying normal and impaired lung growth and lung maturation before birth. The airways of…