Fetal assessment

Clinical research in the area of fetal assessment, both antepartum and intrapartum, is a focus of the Division of Maternal-Fetal Medicine.

Ultrasound assessment of the fetus. The impact of routine ultrasound for the detection of fetal anomalies--its cost, benefit, success, and the ethical issues involved in offering or withholding this diagnostic test are currently being studied in our unit. In addition, we are examining the indications for invasive fetal therapy (i.e., cordocentesis, thoracocentesis, vesicocentesis, and shunt therapy) for the treatment of fetal anomalies, Rh alloimmunization, fetal infections in utero, and other fetal problems discovered antenatally.

Complications of multiple gestations. We are currently spearheading a multicenter trial of the treatment of twin-twin transfusion syndrome, a severe problem affecting the fetuses in a monochorionic pregnancy. Recent work also includes retrospective studies of the maternal risk of complications in higher order multiple gestations, specifically preeclampsia, where we have demonstrated a markedly increased rate of severe preeclampsia in triplet pregnancies compared to those with twins.

Intrapartum fetal assessment. Our determination of a lack of scientific information on the management of fetal bradycardia in labor led us to develop and report on a survey study of Maternal-Fetal Medicine physicians' practices when faced with this severe problem, providing more information for practicing obstetricians, and providing a framework for the incorporation of survey data into clinical practice.