Ethics and professional responsibility: Essential dimensions of planned home birth
Planned home birth is a paradigmatic case study of the importance of ethics and professionalism in contemporary perinatology. In this article we provide a summary of recent analyses of the Centers for Disease Control database on attendants and birth outcomes in the United States. This summary documents the increased risks of neonatal mortality and morbidity of planned home birth as well as bias in Apgar scoring. We then describe the professional responsibility model of obstetric ethics, which is based on the professional medical ethics of two major figures in the history of medical ethics, Drs. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - January 20, 2016 Category: Perinatology & Neonatology Authors: Laurence B. McCullough, Amos Gr ünebaum, Birgit Arabin, Robert L. Brent, Malcolm I. Levene, Frank A. Chervenak Source Type: research
Ethical issues in neonatal research involving human subjects
This article describes some examples of historical and modern controversies in neonatal research, discusses the justification for research involving such vulnerable and fragile patients, clarifies current federal regulations that govern research involving neonates, and suggests ways that clinical investigators can develop and implement ethically grounded human subjects research. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - January 20, 2016 Category: Perinatology & Neonatology Authors: Alan R. Fleischman Source Type: research
Responding to refusal of recommended cesarean section: Promoting good parenting
This article argues when a cesarean section is required to prevent death or serious disability for a fetus, the pregnant woman has an ethical (although not legal) obligation to undergo that procedure even when she has concerns or conflicting commitments. Further, a clinician may be justified in using persuasive counseling when there is grave harm at stake that the patient has a moral obligation to prevent. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - January 20, 2016 Category: Perinatology & Neonatology Authors: Janet Malek Source Type: research
Responding to refusal of recommended cesarean section: Promoting good parenting
This article argues when a cesarean section is required to prevent death or serious disability for a fetus, the pregnant woman has an ethical (although not legal) obligation to undergo that procedure even when she has concerns or conflicting commitments. Further, a clinician may be justified in using persuasive counseling when there is grave harm at stake that the patient has a moral obligation to prevent. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - January 19, 2016 Category: Perinatology & Neonatology Authors: Janet Malek Source Type: research
Maternal mortality in New York—Looking back, looking forward
New York City was ahead of its time in recognizing the issue of maternal death and the need for proper statistics. New York has also documented since the 1950s the enormous public health challenge of racial disparities in maternal mortality. This paper addresses the history of the first Safe Motherhood Initiative (SMI), a voluntary program in New York State to review reported cases of maternal deaths in hospitals. Review teams found that timely recognition and intervention in patients with serious morbidity could have prevented many of the deaths reviewed. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - January 19, 2016 Category: Perinatology & Neonatology Authors: Cynthia Chazotte, Mary E. D’Alton Source Type: research
Ethical challenges in the new world of maternal–fetal surgery
This article explores some of the complex ethical challenges that exist in the field of fetal diagnosis and treatment, especially surrounding maternal–fetal surgery. The rise of these new treatments force us to reconsider who or what is the fetus, what are our obligations to the fetus, and what are the limits to those obligations. In addition, we will consider provider and professional biases, disability issues, and how maternal–fetal surgery has, for a select group of women, changed the very experience of motherhood. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - January 19, 2016 Category: Perinatology & Neonatology Authors: Ryan M. Antiel Source Type: research
Ethical challenges in the new world of maternal –fetal surgery
This article explores some of the complex ethical challenges that exist in the field of fetal diagnosis and treatment, especially surrounding maternal –fetal surgery. The rise of these new treatments force us to reconsider who or what is the fetus, what are our obligations to the fetus, and what are the limits to those obligations. In addition, we will consider provider and professional biases, disability issues, and how maternal–fetal surgery has, for a select group of women, changed the very experience of motherhood. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - January 18, 2016 Category: Perinatology & Neonatology Authors: Ryan M. Antiel Source Type: research
Drugs for neuroprotection after birth asphyxia: Pharmacologic adjuncts to hypothermia
An adverse outcome is still encountered in 45% of full-term neonates with perinatal asphyxia who are treated with moderate hypothermia. At present pharmacologic therapies are developed to be added to hypothermia. In the present article, these potential neuroprotective interventions are described based on the molecular pathways set in motion during fetal hypoxia and following reoxygenation and reperfusion after birth. These pathways include excessive production of excitotoxins with subsequent over-stimulation of NMDA receptors and calcium influx in neuronal cells, excessive production of reactive oxygen and nitrogen species...
Source: Seminars in Perinatology - January 18, 2016 Category: Perinatology & Neonatology Authors: Frank van Bel, Floris Groenendaal Source Type: research
Stem cell–based therapies for the newborn lung and brain: Possibilities and challenges
There have been substantial advances in neonatal medical care over the past 2 decades that have resulted in the increased survival of very low birth weight infants, survival that in some centers extends to 22 weeks gestational age. Despite these advances, there continues to be significant morbidity associated with extreme preterm birth that includes both short-term and long-term pulmonary and neurologic consequences. No single therapy has proven to be effective in preventing or treating either developmental lung and brain injuries in preterm infants or the hypoxic-ischemic injury that can be inflicted on the full-term brai...
Source: Seminars in Perinatology - January 14, 2016 Category: Perinatology & Neonatology Authors: S. Alex Mitsialis, Stella Kourembanas Source Type: research
Pharmacologic strategies in neonatal pulmonary hypertension other than nitric oxide
Inhaled nitric oxide (iNO) is approved for use in persistent pulmonary hypertension of the newborn (PPHN) but does not lead to sustained improvement in oxygenation in one-third of patients with PPHN. Inhaled NO is less effective in the management of PPHN secondary to congenital diaphragmatic hernia (CDH), extreme prematurity, and bronchopulmonary dysplasia (BPD). Intravenous pulmonary vasodilators such as prostacyclin, alprostadil, sildenafil, and milrinone have been successfully used in PPHN resistant to iNO. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - January 14, 2016 Category: Perinatology & Neonatology Authors: Satyan Lakshminrusimha, Bobby Mathew, Corinne L. Leach Source Type: research
Hemodynamic instability in the critically ill neonate: An approach to cardiovascular support based on disease pathophysiology
Hemodynamic disturbance in the sick neonate is common, highly diverse in underlying pathophysiology and dynamic. Dysregulated systemic and cerebral blood flow is hypothesized to have a negative impact on neurodevelopmental outcome and survival. An understanding of the physiology of the normal neonate, disease pathophysiology, and the properties of vasoactive medications may improve the quality of care and lead to an improvement in survival free from disability. In this review we present a modern approach to cardiovascular therapy in the sick neonate based on a more thoughtful approach to clinical assessment and actual path...
Source: Seminars in Perinatology - January 14, 2016 Category: Perinatology & Neonatology Authors: Regan E. Giesinger, Patrick J McNamara Source Type: research
Care bundles for management of obstetrical hemorrhage
Peripartum hemorrhage is one of the most preventable causes of maternal mortality worldwide. Much effort has been directed toward creating programs that address deficits in maternity care responsible for preventable hemorrhage-related morbidity and mortality. To have a significant impact on outcomes, such programs must address both providers and processes involved in the delivery of maternity care. At the core of a successful program, are standardized care bundles integrating medical and surgical techniques for managing hemorrhage with principles of transfusion medicine and critical care. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - January 11, 2016 Category: Perinatology & Neonatology Authors: Adiel Fleischer, Natalie Meirowitz Source Type: research
Challenges and lessons learned in Neonatal Drug Therapies
Drugs are extensively used in the newborns and some of these pharmacologic agents are key elements contributing to the improved outcomes and survival of the sick neonates. This issue of the Seminars in Perinatology focuses on the more vexing and promising pharmacologic agents being used and may be potentially used in the newborn. Drugs are molecular entities that elicit a physiologic, biochemical, or molecular response. It is clear that stem cell-based therapies are potent pharmacologic strategies that represent the next breakthrough for neonatal morbidities such as bronchopulmonary dysplasia, periventricular leucomalacia ...
Source: Seminars in Perinatology - January 11, 2016 Category: Perinatology & Neonatology Authors: Jacob V. Aranda Source Type: research
Neonatal abstinence syndrome: Pharmacologic strategies for the mother and infant
Opioid use in pregnancy has increased dramatically over the past decade. Since prenatal opioid use is associated with numerous obstetrical and neonatal complications, this now has become a major public health problem. In particular, in utero opioid exposure can result in neonatal abstinence syndrome (NAS) which is a serious condition characterized by central nervous system hyperirritability and autonomic nervous system dysfunction. The present review seeks to define current practices regarding the approach to the pregnant mother and neonate with prenatal opiate exposure. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - January 11, 2016 Category: Perinatology & Neonatology Authors: Walter K. Kraft, Megan W. Stover, Jonathan M. Davis Source Type: research
