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Prenatal infections have long been recognized as important, preventable causes of developmental disabilities. The list of pathogens that are recognized to have deleterious effects on fetal brain development continues to grow, most recently with the association between Zika virus (ZIKV) and microcephaly. To answer clinical questions in real time about the impact of a novel infection on developmental disabilities, an historical framework is key. The lessons learned from three historically important pathogens: rubella, cytomegalovirus, and ZIKV, and how these lessons are useful to approach emerging congenital infections are discussed in this review. Congenital infections are preventable causes of developmental disabilities and several public health approaches may be used to prevent prenatal infection. When they cannot be prevented, the sequelae of prenatal infection may be treatable. WHAT THIS PAPER ADDS: The list of prenatal infections associated with developmental disabilities continues to increase. Lessons learned from rubella, cytomegalovirus, and Zika virus have implications for new pathogens. Severity of illness in the mother does not correlate with severity of sequelae in the infant., (© 2020 Mac Keith Press.)

The Fetal Treatment Center founded by Michael Harrison is credited as the birthplace of fetal surgery. His trainees in pediatric surgery subsequently founded fetal centers throughout the United States. In Europe, the advent of minimally invasive fetal surgical techniques led to the establishment of treatment centers led predominantly by perinatologists. More recently, perinatologists in North America have begun to play a greater role in the field of fetal intervention.Intrauterine transfusion for the treatment of hemolytic disease of the fetus/newborn was the first successful fetal intervention. Although not subjected to the rigors of clinical trials, this treatment has withstood the test of time. Interventions for other fetal disease states such as twin-twin transfusion and repair of fetal myelomeningocele were investigated in animal models followed by randomized clinical trials before widespread adoption. Tracheal occlusion for diaphragmatic hernia is still currently being investigated as the next promising step in fetal intervention., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Using the German 1970 census to study educational and labor market outcomes of cohorts born during the German food crisis after World War II, I document that those born between November 1945 and May 1946 have significantly lower educational attainment and occupational status than cohorts born shortly before or after. Several alternative explanations for this finding are tested. Most likely, a short spell of severe undernutrition around the end of the war has impaired intrauterine conditions in early pregnancies and resulted in long-term detriments among the affected cohorts. This conjecture is corroborated by evidence from Austria., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Fetal face was the main concern of researchers who developed three-dimensional ultrasound. 3-D ultrasound beginnings date back to 1973. Parallel concerns of researchers from different parts of the world have led to a constantly changing the equipment and software. 3-D images of the fetal face were obtained since 1986, but those that are available on the ultrasound devices sold today dates from 1992, and the 4-D since 1996. Techniques such as volume rendering and multiplanar volume rendering, led to the development of 3-D ultrasound. Late 2000 revealed study fetal face by multiplane three-dimensional ultrasound, through the acquisition of volume and its processing. Study of fetal profile by this method provides new data on the jaw, naso-maxillo-mandibular angle, even a diagram of the fetal profile or of dimensions of the fetal face or nasal bone length. Fetal profile analyzed by 16 parameters measured by 3-D ultrasound, with the creation of a craniofacial index variable is useful in assessing normal and abnormal fetal face. Today, the bones of fetal face--nose, jaw, bone palace, those of the orbit, can be studied in dynamics, from 12-14 gestational weeks. The best ultrasound images can be obtained after 21 gestational weeks, when fetal size and its ratio with amniotic fluid are optimal for the acquisition of fetal volume.

Unlabelled: Intrauterine seizure is a rare event. Genetic predisposition and trauma are possible risk factors., Objective: To review and comment on the historical description of intrauterine events of a bastard daughter of Dom Pedro I (Maria Isabel Alcântara Brasileira - 1830-1896)., Method: Review of historical facts about the health of Dom Pedro I's daughter according to primary and secondary historical data., Results: According to historical accounts, Dom Pedro I's daughter suffered trauma during the intrauterine period that provoked intrauterine seizures. At the age of eight years, she developed self-limited and benign generalized epilepsy. Like her father, she had mood problems and also learning difficulties., Conclusion: Dona Maria Isabel's own report does not shown sufficient evidence to support the diagnosis of post-traumatic intrauterine seizures. Nevertheless, her family history suggests a genetic basis for her epilepsy.

Over the past 3 decades, fetal surgery for congenital disease has evolved from merely a fanciful concept to a medical field in its own right. Techniques for open hysterotomy, minimal-access hysteroscopy, and image-guided percutaneous fetal access have become well established, first in animal models and subsequently in humans. At the same time, major advances in fetal imaging and diagnosis, anesthesia, and tocolysis have allowed fetal intervention to become a vital tool for subsets of patients who would otherwise endure significant morbidity and mortality. This article offers a concise overview of the history of fetal surgery, from its tumultuous early days to its current status as an important means for the early treatment of potentially devastating congenital anomalies.

It is important to recognize that it is only during our lifetime, the last decades of the 20th century, that the fetus has become a patient, with much of the credit due to the powerful imaging and sampling techniques now available. The secret life of the fetus has been revealed and with it the details of normal fetal growth and development and the opportunity to identify, detect, and treat fetal anomalies surgically. From a nursing perspective, this article provides a historical overview of fetal treatment, including the development and evolution of fetal surgery, a description of some milestones of this multifaceted, complex area, a delineation of the components and dynamics of collaborative team management of fetal therapy patients, and finally an introduction to introduce emerging trends that will affect the future of this rapidly evolving field.

These four individuals are recognized because at a critical point in the evolution of maternal-fetal surgery they contributed in ways that uniquely advanced progress in the field, enabling other researchers to make even greater discoveries. They were not the only significant contributors; there were many, too numerous to recount. Although their contributions were crucial, other researchers accomplished more. Among their peers, however, these four pioneers stand out because at a critical nexus their vision and perseverance carried researchers forward to a new level of excellence. We all follow in their footsteps.

The authors provide an account of their 20-year-old history of collaborative research and publication at Cornell University on ethics in fetal diagnosis and therapy. This research first developed and applied a conceptual framework for ethics in maternal-fetal medicine based on the concept of the fetus as a patient. The basic elements of this framework are described, as well as their application to fetal diagnosis and fetal therapy. Related topics, including obstetrics and gynecology, clinical medicine, managed care, and the ethical dimensions of medical leadership, are also briefly described., (Copyright 2003 S. Karger AG, Basel)

A genetic theory of "multifactorial" malformations, i.e., anomalies of blastogenesis or organogenesis, involving polygenic predisposition with morphogenetic threshold effect, was developed by Sewall Wright in the 1920s and remains an essential basis of birth defects biology. Because of the phenomenon of universality, i.e., the deployment of identical inductive, or pattern-forming, upstream molecular mechanisms during the earliest stages of mammalian morphogenesis, Wright's work on guinea pig otocephaly is highly pertinent to "corresponding," i.e., homologous malformations in humans. This concept is illustrated on the hand of a human fetus in the Vilnius (Lithuania) Pathological Museum with anotocephaly, i.e., anencephaly and otocephaly so severe as to correspond to Wright's guinea pig otocephaly grade 11 or 12. The observation also supports our apology for old museums and old books as repositories for anomalies, no less important for their rarity., (Copyright 2001 Wiley-Liss, Inc.)

It is well-known that Ignác Semmelweis discovered the etiology and prophylaxis of puerperal sepsis. However, few historians have focused on his understanding of the pathophysiology of fetal and neonatal sepsis. Based on several key observations, Semmelweis realized that puerperal fever (also known as "childbed fever") could be transmitted to the fetus, especially when the first stage of labor was prolonged and multiple examiners performed vaginal examinations while their fingers were contaminated. This insight was particularly valuable in that it helped him decipher the mystery of puerperal sepsis. This paper presents some of these concepts and supporting evidence.

In this article, we record the history of obstetric ultrasound as it developed worldwide in the second half of the twentieth century. The technological advances during this period saw the evolution of equipment from the original adapted metal flaw detectors producing a simple A-scan to the modern, purpose built, real-time colour flow machines with three-dimensional capability (Fig. 1). Clinically, ultrasound began as a research tool, but the poor quality of the images led to the ridicule of many of the early investigators. However, because of their perseverance, ultrasound developed into an imaging modality providing immense diagnostic capabilities and facilitating with precision many invasive procedures, diagnostic and therapeutic, both of which have made significant contributions to patient care. In this history, we recall the people, the personalities, and the problems they encountered during the development of ultrasound and how these problems were resolved, so that ultrasound now is available for use in the care of pregnant women throughout the developed world.

Identification of a 3100-year-old lithopedion in the Archaic Southwest antedates its first clinical notation by 2100 years. It was only the "autopsy" of time (excavation of the site) that allowed its presence to be brought to light.

The concept that the fetus may be a patient is very recent. Modern ultrasonography can detect fetal abnormalities early in utero, and lead to prenatal correction of such malformations. At present three anatomic defects can benefit from fetal surgery: diaphragmatic hernia, urethral obstructions and obstructive hydrocephalus. The feasibility of fetal surgery has been proved both experimentally and clinically. Microsurgery can be of great help in this type of surgery. At this stage, fetal surgery should be pursued only in very qualified centers.

The obscuring effect of the diploe in the skull for attempts to use ultrasonic energy to image the brain is not present in the fetus, neonate or infant prior to ossification of the skull. Initially, however, the fetal examination was largely confined to a single measurement of the size of the skull, usually in the bi-parietal plane, just prior to labour. In this way it became possible to identify immature fetuses where delivery should be delayed as long as possible, as well as cases of cephalo-pelvic disproportion where the large size of the fetal head would make vaginal delivery difficult. Measurements made earlier in pregnancy, in order to predict the gestational age and estimated date of delivery, would only be accurate if all fetal heads were the same size at every gestational age. Similarly, attempts to predict birthweight from the size of the fetal head at any given gestational age foundered both upon the uncertainty of determining the gestational age from the menstrual history and upon the variations in the size of fetuses for various gestational ages. By making serial measurements of fetal head size, the rate of fetal growth can be measured. In this way, it is possible to separate the normal fetus which appeared to be small for its gestational age because the gestational age had been erroneously calculated from the menstrual history, from two clinically important groups. In the first group, the fetus is small and grows abnormally slowly throughout the whole pregnancy because of some congenital defect; and in the second the rate of growth becomes slowed towards the end of pregnancy because the placenta is no longer able to supply the increased nutritional needs of the mature fetus. Where it is not possible to make serial measurements throughout pregnancy, they can often be restricted to two measurements. The first is made in mid-pregnancy and, if the size of the fetal head agrees with that predicted from the menstrual history, it is assumed that the fetus is not abnormally small due to some congenital defect. In such cases the only other examination that needs to be made is another measurement near term to identify cases of placental insufficiency. If the first measurement does not coincide with that expected from the menstrual history, then more frequent measurements should be made in order to separate those normal fetuses in which the gestational age was wrongly calculated from the menstrual history from those fetuses with growth retardation throughout pregnancy due to some abnormality.(ABSTRACT TRUNCATED AT 400 WORDS)

At a time when the intrauterine diagnosis of hydrocephalus is commonplace and pioneering efforts of antenatal therapy are evolving, review of the chronology of treatment of this disorder becomes pertinent. The history of therapy of hydrocephalus may be divided into three phases. The first two largely involved accumulation of basic anatomical and pathophysiological information. The last phase dates only from the 1950s and may be considered an era of rapid technical development. This account discloses the obligatory relationship between useful therapy and basic knowledge.

Prolapse of the umbilical cord which is still, nowadays, a very dangerous ailment for the fetus, is the type of obstetrical emergency where a quick therapeutic decision may save the child. Its current management is perfectly organized and the authors thought it would be interesting to retrace the history of ideas and techniques leading to the current concepts.

The past history of fetal surgery is briefly reviewed. The current controversies revolving around the fetal treatment of hydrocephalus and obstructive uropathies (posterior urethral valves, prune belly syndrome, hydronephrosis) are compared and contrasted with the remarkably similar controversies that raged when fetal transfusions were first introduced. The future of fetal surgery is discussed in the light of the ethical issues raised by the prospect of fetal surgery and the rather disturbing medicolegal climate. There are already important legal precedents which will affect the field of fetal surgery. The strong opinion is expressed that fetal surgery must only remain an option offered to the mother and never forced upon her.