The image of obstetrics as a largely manipulative art has changed
radically in recent years. The risk to a healthy mother of
pregnancy and labour has been markedly reduced and morbidity not
mortality is the yardstick by which the quality of maternal care is
judged. We are now able to devote far more attention to the fetus
whose growth patterns and behaviour in utero can be studied in
detail by modern and sophisticated technical aids with a resultant
improvement in perinatal mortality. A patient with a pre-existing
general disease, however, still presents a problem which is best
managed by close co-operation between obstetrician and physician.
Essential hypertension, diabetes, heart disease, thyroid disease
and epilepsy are examples of disorders which require great care
throughout pregnancy and during labour if good maternal and fetal
results are to be obtained. There are many questions still to be
answered. What is the place of hypotensive therapy in essential
hypertension complicating pregnancy? When should delivery take
place in the pregnant diabetic? How should the patient be
delivered? What should be her management during labour? What is the
risk of fetal abnormality in the epileptic patient who becomes
pregnant whilst on anti-epileptic drugs? These questions and others
have been the subject of a recent symposium in the Institute of
Obstetrics and Gynaecology.
General
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