Ethics is an essential dimension of obstetrical practice. In this paper, authors have developed a framework for clinical judgment and decision-making about the ethical dimensions of the obstetrician-patient relationship. Authors emphasize a preventive ethics approach that appreciates the potential for ethical conflict and adopts ethically justified strategies to prevent those conflicts from occurring.  First defined are ethics, medical ethics, and the fundamental ethical principles of medical ethics, beneficence and respect for autonomy. Authors then show how these two principles should interact in obstetric judgment and practice, with emphasis on the core concept of the fetus as a patient.Read More

Preeclampsia is a major cause of maternal and perinatal mortality and morbidity worldwide. Its etiology is elusive and theories abound regarding its pathogenesis. Preeclampsia can cause changes in virtually all organ systems. Several organ systems are consistently and characteristically involved. The pathologic findings indicate that the pathogenetic factor of primary importance is not blood pressure elevation, but rather poor tissue perfusion. The histologic data support the clinical impression that the poor perfusion is secondary to profound vasospasm, which also increases total peripheral resistance and blood pressure. Preeclampsia is not merely an alternate form of malignant hypertension. Recently homocysteine, a metabolite of the essential amino acid methionine has been postulated to produce oxidative stress and endothelial cell dysfunction, alterations associated with preeclampsia. The studies examining the relationship between serum homocysteine concentrations and preeclampsia are also discussed.Read More

Group B streptococci (GBS) emerged dramatically in the 1970s as the leading cause of neonatal infection and as an important cause of maternal uterine infection. In 2002, new national guidelines were released recommending: 1) solely a screen-based prevention strategy, 2) a new algorithm for patients with penicillin allergy, and 3) more specific practices in certain clinical scenarios. In the pre-prevention era, active surveillance for invasive neonatal GBS disease estimated that approximately 6,100 early-onset cases and 1,400 late-onset cases occurred annually in the United States.  The purpose of this document is to address clinical issues of group B streptococci (GBS) perinatal infection, implementation of new diagnostic techniques, management of preterm rupture of membranes, use of alternative antibiotic approaches, improvement of compliance, prevention of low birth-weight infants, emergence of resistant organisms and vaccine development.Read More

Screening for Down syndrome is an important part of routine antenatal care. Significant advances have been made in antenatal screening for Down syndrome over the past few decades. The most common screening method in the United States involves the assessment of a combination of factors: maternal age, multiple second-trimester serum markers, and second-trimester ultrasonography. More recently there has been significant interest in first-trimester methods of screening, including screening for first-trimester markers and the sonographic measurement of fetal nuchal translucency. Invasive prenatal diagnosis for Down syndrome with amniocentesis or chorionic villus sample (CVS) is offered only to women of advanced maternal age (older than 35 years at delivery) or those who previously had an affected child or to women who has abnormal multiple-marker serum screening. The most efficient multiple-marker screening test in the second trimester is the "quad" screen, comprising alpha-fetoprotein (AFP), human chorionic Gonadotropin (hCG), unconjugated estriol (E3), and Inhibin-A. This approach yields sensitivities for Down syndrome of 67-76%. The purpose of the document is to summarize the current data and shift toward first-trimester screening for Down syndromeRead More