Advances in perinatal medical care--from our experience

In the last 30 years, maternal and perinatal mortality rates have markedly improved in Japan. These results are supported by the advanced technologies and newly developed treatments in obstetric and neonatal medicine, the evidence of which will be described through the authors' experiences. Ultrasound-guided treatments for fetuses and pediatric surgery for extremely tiny infants have been performed with cooperation among cardiac surgeons, anesthesiologists and perinatologists. The remarkable achievements in neonatal medicine are surfactant replacement therapy, application of high frequency oscillation (HFO) respirator, nitric oxide and extracorporeal membrane oxygenation (ECMO) systems and transcutaneous blood gas monitoring. The possibility to have a safe pregnancy and delivery arose for women with severe medical complications such as diabetes mellitus (DM), heart diseases, and hemo-dialysis, factors formerly regarded as contraindications to pregnancy. The accumulative data of these high-risk pregnancies treated in our center are introduced. It is noted that molecular mechanisms in fetal growth have been elucidated to some extent. The insulin-like growth factor I (IGF-I) and IGF-binding protein 1 (IGFBP1) system, and cytokines, are involved in the fetal growth. Newly developed treatments such as urinary trypsin inhibitor (Urinastatin) for prevention of preterm delivery and amnioinfusion to cases of preterm premature rupture of the membrane are summarized. Finally, the reference to advanced medicine and its side effects lead to broad discussions regarding the future development of perinatal medicine.