Reflections on future directions of perinatal medicine

Up to the immediate past, and perhaps even to the present, a major difference between care of the fetus and of the neonate was the ability to examine directly the physical and biochemical traits of the unborn patient. In a span of time as short as perhaps 10 years it has become progressively possible to institute almost all neonatal investigative maneuvers to the fetus. In the last 5 years, the concept of treating the decreased fetus in utero has developed from a multitude of sources. The psychological, physical, and therapeutic barriers between the fetus and newborn are sharply eroded now, and may soon disappear. The impact on the advances discussed is likely to be very significant, since the near elimination of all late gestation (greater than 20 weeks) perinatal death is not unrealistic, and a major thrust in either preventing or ameliorating disease of genetic origin is at least worthy of serious contemplation. With each advance, either concrete or speculative, comes a need to reassign training priorities, professional self-definition, societal resources, and societal priorities. The distinct possibility of achieving near excellence in perinatal care exists. The possibility that society and its physicians would wish to ensure that such events are entirely desirable despite the cost is less certain. It is likely that the definitive confrontation will occur on this field.