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[Review, present and prospects of obstetrics]
1Universitätsklinik für Frauenheilkunde, Wien, Osterreich. peter.husslein@akh-wien.ac.at
Insights
Perinatal mortality has significantly decreased due to improved management of premature infants and advancements in neonatology. Sociological shifts and increased legal actions are creating a more challenging environment for obstetric care.
Area of Science:
- Obstetrics and Gynecology
- Perinatology
- Neonatology
Background:
- Perinatal mortality has seen a dramatic reduction over the past 25 years, decreasing from approximately 25 to below 6 deaths per 1000 births.
- This improvement is attributed to enhanced management of premature infants rather than a reduction in premature births.
Purpose of the Study:
- To review key developments in obstetrics over the last 25 years.
- To analyze factors contributing to reduced perinatal mortality.
- To discuss emerging trends and challenges in modern obstetrics.
Main Methods:
- Review of medical advancements in fetal organ maturity induction (corticosteroids) and antenatal transfer protocols.
- Analysis of improvements in neonatal care, including surfactant therapy and respiratory support.
- Examination of the role of prostaglandins in labor induction and treatment of postpartum atonia.
- Consideration of sociological influences such as patient autonomy and legal recourse.
Main Results:
- Significant reduction in perinatal mortality achieved through better care for premature infants.
- Key interventions include fetal organ maturity induction, antenatal transfer, improved neonatal care, and use of prostaglandins.
- Sociological factors, including patient empowerment and increased litigation, are reshaping obstetric practice.
Conclusions:
- Advances in fetal and neonatal care have drastically improved perinatal outcomes.
- Future obstetric practice will be influenced by patient-centered care, evolving medical technologies, and a more litigious environment.
- An increase in Cesarean sections is anticipated due to awareness of pelvic floor injuries from vaginal delivery.
Abstract:
During the last 25 years, the most impressive development in obstetrics has been the reduction of perinatal mortality from approximately 25 to below 6. Contrary to the expectations of those days, this has not been achieved by a decreased rate of premature births but by a better management of prematurely born babies, particularly by the induction of fetal organ maturity by corticosteroids and the antenatal transfer of high-risk pregnant women to a perinatal care centre. A more careful birth management and the corresponding ameliorations in neonatology (e.g. dosing of surfactants, less invasive methods of artificial respiration) have also contributed to the better results. The introduction of the prostaglandins to expel the fetus, the induction of delivery treatment of postpartal atonia were other milestones in the of obstetrics. Apart from these medical developments, sociological trends shaped obstetrics too, and these will influence it future: the increasing importance of the patient's will, paramedical factors in obstetrics and the heightened readiness to go to court in case of supposed damage. In obstetrics, the next few decades will show an uncheckable increase in the frequency of caesarean sections, due to - among other factors - the knowledge that vaginal deliveries cause injuries of the pelvic floor which have mostly been disregarded until now. Because of the expected decrease in birth rates, the increased number of doctors and midwives, the more and more demanding attitude of the population and the relentless readiness of supposedly injured patients to take legal action, the environment for obstetricians well become even more difficult in the future.