The state of health care is reflected by perinatal and neonatal
morbidity and mortality as well as by the frequencies of long-term
neurologic and developmental disorders. Many factors, some"without
immediately recognizable significance to childbearing and many
still unknown, undoubtedly contribute beneficially or adversely to
the outcome of pregnancy. Knowledge concerning the impact of such
factors on the fetus and surviving infant is critical. Confounding
analyses of pregnancy outcome, especially these past two or three
decades, are the effects of newly undertaken invasive or inactive
therapeutic approaches coupled with the advent of high technology.
Many innovations have been intro duced without serious efforts to
evaluate their impact prospectively and objectively. The
consequences of therapeutic misadventures character ized the past;
it seems they have been replaced to a degree by some of the
complications of applied technology. Examples abound: after ov
eruse of oxygen was recognized to cause retrolental fibroplasia,
its restriction led to an increase in both neonatal death rates and
neurologic damage in surviving infants. Administration of vitamin K
to prevent neonatal hemorrhagic disease, particularly when given in
what we now know as excessive dosage, occasionally resulted in
kernicterus. Prophy lactic sulfonamide use had a similar end
result. More recent is the observation of bronchopulmonary
dysplasia as a complication of re spirator therapy for hyaline
membrane disease. The decade of the eighties opened with the
all-time highest rate of cesarean section in the United States."
General
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