Recent advances: Fetal medicine

In the 13 years since the first annual symposium of “The Fetus as a Patient,” diagnostic skills with fetal disease have improved enormously, but therapeutic approaches remain limited. Periconceptual folate, maternal steroids, and fetal blood transfusion are the best examples of preventive, transplacental, and invasive treatments, respectively, and all three were developed more than a decade ago. Arguably, the most significant advance is that most professionals and parents consider the fetus as a separate individual and a potential patient in his or her own right. Indeed, once the fetus is recognised to be at risk the perinatal outcome is better than in an apparently low risk pregnancy.1 Antepartum “unexplained” fetal death is by far the commonest cause of death between 20 weeks’ gestation and the age of one year, comprising nearly 40% of deaths in this period.2 The main challenge in pregnancy care is to improve fetal surveillance in low risk pregnancies so that potentially compromised fetuses can be identified.