Introduction

Abstract

Antenatal care in this century has undergone a sea change. It began as a charitable concern for the indigent, often unmarried, mother. As, one by one, the causes of maternal death were eliminated, the focus of care shifted to her unborn baby. Now we are approaching the point where nearly every established pregnancy ends in the birth of a live, surviving baby, and the proper concern of antenatal care is with the quality of the product. This book is written at the transition point. Obstetricians can make reasonably reliable guesses as to whether a fetus has a better chance of survival in the uterus or out of it; obstetric services can produce it alive and paediatricians can keep it alive. But there our powers end. We can do very little about the loss of life before pregnancy is established and no more about treating the ills which might beset the fetus in utero. Our purpose is to examine some of the means which might be used to determine how far the fetus is affected by the hazards of pregnancy and thus to provide some forecast of the outcome. With perinatal deaths ranging from 12 to 20 per 1000 births in Britain, we still have some way to go before every baby which can be saved, survives. It is here that biochemical monitoring of the fetus can make a contribution to the choice of the few alternative lines of action open to us.