Fifty years of obstetrics and gynaecology.

The term 'obstetrics and gynaecology' now feels like an outmoded name for women's health care. Since the 1960s the specialty has been transformed by social change, technical innovation and medical subspecialization, although the core values of good clinical practice remain unchanged.

Malformações congênitas: aspectos maternos e perinatais / Congenital defects: maternal and perinatal features

Introdução: As malformações congênitas são todas as anomalias funcionais ou estruturais do desenvolvimento fetal decorrentes de fatores originados anteriormente ao nascimento, de causas genética, ambiental ou desconhecida e estão relacionadas com elevada morbi-mortalidade perinatal. Objetivo: Identificar a prevalência das malformações congênitas e de aspectos maternos e perinatais relacionados às deformidades. Metodologia: Estudo transversal, do tipo caso-controle, dos nascimentos ocorridos no Hospital Geral da Universidade de Caxias do Sul, no período de 1998 a 2007. Os dados foram armazenados no SPSS, versão 16.0. Foram utilizados teste T de Student e o teste de Mann-Whitney, com nível de significância estatística p<0,05. Resultados: Dentre os 14.351 nascimentos foram identificados 247 casos (1,7%) de recém-nascidos portadores de algum tipo de malformação congênita: geniturinárias (n=55), associação de malformações (n=53), sistema músculo-esquelético (n=45), sistema nervoso central (n=43), gastrintestinais (n=29) e cardiovasculares (n=22). Idade materna, diabete melito, cor da pele, intervalo interpartal, paridade e ocorrência de ameaça de interrupção precoce da gestação não apresentaram associação significativa com as MCs citadas. Via de parto, peso do concepto no nascimento, ocorrência de PIG, necessidade de tratamento em ambiente de intensivismo neonatal, apresentação pélvica, idade gestacional média, natimortalidade, oligodrâmnio e polidrâmnio associaram-se significativamente à presença do defeito congênito (p<0,001). Conclusão: As malformações congênitas de maior prevalência foram geniturinária e associação de malformações. Esta última condição e as malformações do sistema nervoso central estiveram mais associadas ao óbito perinatal.

Introduction: Congenital malformations (CMs) are all the functional or structural abnormalities of the fetal growth, resulting from prenatal factors of genetic, environmental or idiopathic etiology, and they are associated with high perinatal morbidity and mortality rates. Aim: To identify the prevalence of congenital malformations and maternal and perinatal features related to deformities. Methods: This is a transversal, case-control study of the births occurring in the General Hospital of the University of Caxias do Sul from 1998 to 2007. The data were analyzed using software SPSS, 16.0. A statistical analysis was carried out using Student’s t-test and Mann-Whitney’s test with significance at p<0.05. Results: Among 14.351 births, 247 cases (1.7%) of newborns with some type of congenital malformation were identified as follows: genitourinary (n=55), combined malformations (n=53), musculoskeletal system (n=45), central nervous system (n=43), gastrointestinal (n=29), and cardiovascular (n=22) malformations. Maternal age, diabetes mellitus, skin color, interparturition interval, parity, and occurrence of threat of early interruption of gestation, were not significantly associated with the mentioned CMs. Delivery route, birth weight, occurrence of SGA, need for neonatal intensive care, breech presentation, mean gestational age, stillbirth rate,oligohydramnios and polyhydramnios were significantly associated with the presence of congenital defects (p<0.001). Conclusion: The congenital alformations of higher prevalence were the genitourinary and the combined malformations. The latter and the central nervous system malformations were more associated with perinatal death.

A history of fetal surgery.

Over the past 3 decades, fetal surgery for congenital disease has evolved from merely a fanciful concept to a medical field in its own right. Techniques for open hysterotomy, minimal-access hysteroscopy, and image-guided percutaneous fetal access have become well established, first in animal models and subsequently in humans. At the same time, major advances in fetal imaging and diagnosis, anesthesia, and tocolysis have allowed fetal intervention to become a vital tool for subsets of patients who would otherwise endure significant morbidity and mortality. This article offers a concise overview of the history of fetal surgery, from its tumultuous early days to its current status as an important means for the early treatment of potentially devastating congenital anomalies.

The birth of perinatal medicine in the United Kingdom.

Slow but steady progress in the medical care of mothers and their infants during the 16th-19th centuries received a setback early in the 20th century following a shift of focus from the baby towards gynaecological surgery. The development of paediatrics after 1928 and the formation of a national health service in 1948 led to a renewed interest in the fetus and newborn infant. Special care baby units (SBCUs) were created in the 1960s. At this time, too, obstetric technology arrived in the delivery room and domiciliary birth largely gave way to hospital delivery. Neonatal intensive care arrived in the 1970s. However, a severe lack of resources retarded progress. Many medical reports in the 1970s drew attention to the deplorable situation. In 1980 a House of Commons working party called for the establishment of a sound perinatal service. In 1982 the Government recognized all newborn infants as NHS patients from the moment of birth rather than after their registration. That year too the Royal College of Obstetricians and Gynaecologists (RCOG) acknowledged the need for a subspecialty in maternal and fetal medicine. Meanwhile, a paediatric perinatal pressure group, arising in 1976, became a multidisciplinary association of perinatal medicine in 1981. By 1983 the new discipline of perinatal medicine had become firmly established.

Fetal treatment center: history, infrastructure, and nursing perspective.

It is important to recognize that it is only during our lifetime, the last decades of the 20th century, that the fetus has become a patient, with much of the credit due to the powerful imaging and sampling techniques now available. The secret life of the fetus has been revealed and with it the details of normal fetal growth and development and the opportunity to identify, detect, and treat fetal anomalies surgically. From a nursing perspective, this article provides a historical overview of fetal treatment, including the development and evolution of fetal surgery, a description of some milestones of this multifaceted, complex area, a delineation of the components and dynamics of collaborative team management of fetal therapy patients, and finally an introduction to introduce emerging trends that will affect the future of this rapidly evolving field.

The birth of perinatal medicine in the United Kingdom.

Slow but steady progress in the medical care of mothers and their infants during the 16th-19th centuries received a setback early in the 20th century following a shift of focus from the baby towards gynaecological surgery. The development of paediatrics after 1928 and the formation of a national health service in 1948 led to a renewed interest in the fetus and newborn infant. Special care baby units (SBCUs) were created in the 1960s. At this time, too, obstetric technology arrived in the delivery room and domiciliary birth largely gave way to hospital delivery. Neonatal intensive care arrived in the 1970s. However, a severe lack of resources retarded progress. Many medical reports in the 1970s drew attention to the deplorable situation. In 1980 a House of Commons working party called for the establishment of a sound perinatal service. In 1982 the Government recognized all newborn infants as NHS patients from the moment of birth rather than after their registration. That year too the Royal College of Obstetricians and Gynaecologists (RCOG) acknowledged the need for a subspecialty in maternal and fetal medicine. Meanwhile, a paediatric perinatal pressure group, arising in 1976, became a multidisciplinary association of perinatal medicine in 1981. By 1983 the new discipline of perinatal medicine had become firmly established.

In their footsteps: a brief history of maternal-fetal surgery.

These four individuals are recognized because at a critical point in the evolution of maternal-fetal surgery they contributed in ways that uniquely advanced progress in the field, enabling other researchers to make even greater discoveries. They were not the only significant contributors; there were many, too numerous to recount. Although their contributions were crucial, other researchers accomplished more. Among their peers, however, these four pioneers stand out because at a critical nexus their vision and perseverance carried researchers forward to a new level of excellence. We all follow in their footsteps.

"La princesa 3 Pedernal Serpiente Emplumada": símbolo del Instituto Nacional de Perinatología / Princess 3 flint feathered serpent: symbol of the National Perinatology Institute

Se presenta una revisión etnohistórica e iconográfica, dentro del contexto de Mesoamérica, acerca del parto de la "Princesa 3 Pedernal Serpiente Emplumada", emblema del Instituto Nacional de Perinatología (INPer); el cual fue seleccionado por el Dr. Eduardo Jurado García, quien fuera el fundador y primer director del instituto. La figura proviene de un códice prehispánico de la región Mixteca llamado "Códice Nutall". Se tomó el dibujo del parto, considerándolo representativo del INPer, por las siguientes razones: la princesa está representada en el momento de la expulsión de su hija y se le ve en posición "semisentada"; la recién nacida aún se encuentra unida a su madre por el cordón umbilical, significando el continuum de la vida; al pie de la recién nacida se observa un dibujo que corresponde a un Quechquémitl, pero también pudiera representa la estera o "petate" para que sea acostada. Ello puede significar la atención que los mixtecos daban a los recién nacidos, que ahora podría correlacionarse con los cuidados inmediatos que se brindan al neonato: control de la temperatura corporal, alimentación temprana al seno materno. Finalmente, la escena está rodeada por un círculo que bien se puede interpretar como "todo lo que rodea al nacimineto de un nuevo ser", en una sola palabra: Perinatología

[History of gynecology and perinatology in Croatia. Midwifery. Clinics and hospitals in Zagreb]. / Povijest ginekologije i perinatologije u Hrvatskoj. Primaljstvo. Klinike i bolnice u Zagrebu.

The development of obstetrics in Croatia and the formation of unique discipline of obstetrics and gynecology in Croatia in first ten years of 20th century are presented. The midwifery is mentioned in Croatia for the first time in Dubrovnik in 14th century. The "protomedicus" from Varazdin Johan Baptist Lalangue in 1777 has published the booklet "Brevis institutio de re obstetritia". First public school of midwifery was founded in Zadar on 1820 and the second one in Zagreb in 1877. In Zadar, Ante Kuzmanic, "magister obstetritiae et chirurgiae" published a short textbook "Sixty lessons from midwifery for midwifes", thereafter in 1908 Nikola Lalich "Book for midwifes". In Zagreb, Antun Lobmayer published in 1877 "The midwifery". Gynecology was developing in the second half of 19th century as a part of surgery. On break-time from 19th to 20th century rose the unique medical profession obstetrics and gynecology. In Croatia the unique discipline established Dr Franjo Durst, since he was in 1905 installed for the first head of Royal Country Maternity Hospital in Ilica street and thereafter in 1921 for the first head and university professor of Royal University Clinic for Gynecology and Obstetrics in Petrova street. The evolution of gynecology and obstetrics, respective of perinatology, during last 30 years, in the Zagreb in departments of clinical hospitals "Clinical Hospital Center", "Sestre Milosrdnice", "Merkur" and "Sv. Duh" is presented.

Vigencia de la tecnologia tradicional en perinatologia: area pediatrica / Currency of traditional technology in perinatology: pediatric area

El autor hace un amplio relato de la evolucion historica de la atencion del nino, tanto en la etapa prenatal como en la epoca del recien nacido. Expone coincidencias de manejo sanitario y medico, desde el tiempo de los aborigenes guaranies, hasta el momento actual. Hace notorio que diversos "avances" de nuestra epoca, habian sido rutinas desde hace mucho tiempo, especialmente en lo que respecta a la atencio prenatal e intraparto