Elaine M. Boyle - Emerging Topics and Controversies in Neonatology

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It is inevitable that complications of pregnancy and their obstetric management will impact on the wellbeing of the newborn infant and the care provided by neonatologists. Almost all aspects of obstetrics will be encompassed by this principle. However, in this chapter we have endeavoured to focus on the aspects of obstetrics that are undergoing the greatest change at present and also have the greatest potential to impact on the newborn baby and its wellbeing. Although many of these changes are occurring internationally, particularly in the developed world, there is inevitably a focus on changes to practice within the UK. We have therefore focussed on prematurity (both prevention and intrapartum care) and prevention of stillbirth. Although the latter would seem intuitively to be less relevant to neonatal outcomes, the consequences of the changes in practice that have occurred will impact on the care of neonates especially with a potential increase in iatrogenic prematurity.

Preterm birth is the leading cause of perinatal morbidity and mortality in developed countries []. Approximately one third of preterm births are iatrogenic (e.g. due to conditions such as pre-eclampsia or fetal growth restriction). The remaining preterm births are spontaneous and may occur because of preterm labour with intact membranes or following preterm prelabour rupture of the membranes (PPROM) .

The majority of preterm births will arise in the apparently low-risk obstetric population. Whilst there are lifestyle changes that will impact on preterm birth risk for the population (such as smoking cessation and pregnancy spacing) there are as yet no reliable screening methods or interventions to offer to women in this group. Interventions are therefore usually targeted at women who are recognised as being at high risk of preterm birth [].