This book provides the first clinically comprehensive and practical approach to ethical challenges in perinatal medicine. The first chapter introduces and explains the professional responsibility model of perinatal ethics. The professional responsibility model is based on the medical ethics of two major physician-ethics in the history of Western medical ethics, Dr. John Gregory (1724-1773) of Scotland and Dr. Thomas Percival (1740-1804) of England. The professional responsibility model is used to articulate the ethical concept of the fetus as a patient and to operationalize the ethical principles of beneficence and respect for autonomy. The book provides practical guidance for clinical judgment and decision making with patients about the responsible clinical management of the wide range of issues encountered by perinatologists in clinical practice and research. Topics included: periviability; feticide; intrapartum management; maternal-fetal conflict; innovation for fetal benefit; research for fetal benefit; non-aggressive obstetric management; managing the transition from pregnancy to birth; destructive procedures such as cephalocentesis; critical care for the pregnant patient; home birth; patient-choice cesarean delivery; neonatal care as a trial of management; and setting limits on neonatal care on the basis of clinical judgments of futility.

This book provides the first clinically comprehensive and practical approach to ethical challenges in perinatal medicine. The first chapter introduces and explains the professional responsibility model of perinatal ethics. The professional responsibility model is based on the medical ethics of two major physician-ethics in the history of Western medical ethics, Dr. John Gregory (1724-1773) of Scotland and Dr. Thomas Percival (1740-1804) of England. The professional responsibility model is used to articulate the ethical concept of the fetus as a patient and to operationalize the ethical principles of beneficence and respect for autonomy. The book provides practical guidance for clinical judgment and decision making with patients about the responsible clinical management of the wide range of issues encountered by perinatologists in clinical practice and research. Topics included: periviability; feticide; intrapartum management; maternal-fetal conflict; innovation for fetal benefit; research for fetal benefit; non-aggressive obstetric management; managing the transition from pregnancy to birth; destructive procedures such as cephalocentesis; critical care for the pregnant patient; home birth; patient-choice cesarean delivery; neonatal care as a trial of management; and setting limits on neonatal care on the basis of clinical judgments of futility.

This book offers a comprehensive and clinically practical approach to ethics in the everyday practice of obstetrics and gynecology. The topics the authors address include: contraception, abortion, selective termination of multifetal pregnancies, gynecologic cancer, in vitro fertilization, surrogacy, prenatal diagnosis, fetal therapy, cephalocentisis, prematurity, HIV infection, and court ordered cesarean delivery. The issues involved in making decisions in many of these areas are a source of conflict, and lead to crisis between the physician and patient. One of the book's strengths is its emphasis on prevention and, if prevention fails, management, of the conflicts and crises which arise in these areas of medicine. The authors develop their preventative and management strategies on the basis of a framework for bioethics in the clinical setting. This framework is rigorously established and defended. The authors argue that four virtues -- self effacement, self sacrifice, compassion, and integrity -- generate the physician's obligation to protect and promote the patient's interest. They then identify the three types of patient's interests -- social role interests, subjective interests, and deliberative interests -- and they reinterpret the ethical principles of beneficence and respect for autonomy in terms of these. The concept of the fetus as patient, the physician's obligation to third parties, and the moral standing of fathers and family members are also addressed. The implications of their argument sets the stage for the discussions of prevention and management in the remaining sections of the book. Ethics in Obstetrics and Gynecology is a unique addition to the literature in both biomedical ethics and obstetrics and gynecology. It demonstrates that ethics should be regarded as an essential part of obstetrics and gynecology, and that clinical practice is incomplete without it.

The increasing prevalence of preterm birth in the United States is a complex public health problem that requires multifaceted solutions. Preterm birth is a cluster of problems with a set of overlapping factors of influence. Its causes may include individual-level behavioral and psychosocial factors, sociodemographic and neighborhood characteristics, environmental exposure, medical conditions, infertility treatments, and biological factors. Many of these factors co-occur, particularly in those who are socioeconomically disadvantaged or who are members of racial and ethnic minority groups. While advances in perinatal and neonatal care have improved survival for preterm infants, those infants who do survive have a greater risk than infants born at term for developmental disabilities, health problems, and poor growth. The birth of a preterm infant can also bring considerable emotional and economic costs to families and have implications for public-sector services, such as health insurance, educational, and other social support systems. Preterm Birth assesses the problem with respect to both its causes and outcomes. This book addresses the need for research involving clinical, basic, behavioral, and social science disciplines. By defining and addressing the health and economic consequences of premature birth, this book will be of particular interest to health care professionals, public health officials, policy makers, professional associations and clinical, basic, behavioral, and social science researchers.

This unique book is a first-of-its-kind resource that comprehensively covers each facet and challenge of providing optimal perinatal palliative care. Designed for a wide and multi-disciplinary audience, the subjects covered range from theoretical to the clinical and the practically relevant, and all chapters include case studies that provide real-world scenarios as additional teaching tools for the reader. Perinatal Palliative Care: A Clinical Guide is divided into four sections. Part One provides the foundation, covering an overview of the field, key theories that guide the practice of perinatal palliative care, and includes a discussion of perinatal ethics and parental experiences and needs upon receiving a life-limiting fetal diagnosis. Part Two delves further into practical clinical care, guiding readers through issues of obstetrical management, genetic counseling, neonatal pain management, non-pain symptom management, spiritual care, and perinatal bereavement care. Part Three discusses models of perinatal palliative care, closely examining evidence for different types of PPC programs: from hospital-based programs, to community-based care, and examines issues of interdisciplinary PPC care coordination, birth planning, and team support. Finally, Part Four concludes the book with a close look at special considerations in the field. In this section, racial, ethnic, and cultural perspectives and implications for PPC are discussed, along with lessons in how to provide PPC for a wide-range of clinical and other healthcare workers. The book closes with a look to the future of the field of perinatal palliative care. Thorough and practical, Perinatal Palliative Care: A Clinical Guide is an ideal resource for any healthcare practitioner working with these vulnerable patient populations, from palliative care specialists, to obstetricians, midwifes, neonatologists, hospice providers, nurses, doulas, social workers, chaplains, therapists, ethicists, and child life specialists.

This book presents the latest evidence-based guidelines for perinatal management and is designed to help obstetricians and neonatologists minimize complications and offer patients the best possible care. Since 1960, there has been a significant increase in basic and clinical investigations on normal and pathological pregnancy in the developed world. This has provided insights into the physiopathology of pregnant women, fetuses and newborns and led to the development of new technologies, bringing about a new medical subspecialty: perinatal medicine. The book is divided into eight main sections: The first examines basic periconceptional care and discusses the ethical aspects of perinatology. The next section focuses on prenatal considerations, such as the nutritional aspects of gestation and puerperium, physical exercise during pregnancy, routine laboratory tests, prenatal care of multiple gestations and the role of the neonatologist in prenatal care. The third and fourth sections then explore fetal evaluation, and clinical intercurrences in pregnancy, respectively. The next section addresses pregnancy complications: prevention, diagnosis and management. The sixth section covers the basic aspects of congenital infections and the seventh examines labor and delivery aspects. Lastly, the final section includes chapters on neonatal assistance. Written by leading experts in obstetrics, neonatology, and perinatology, this thoroughly updated, comprehensive resource reflects the latest information in all areas, including genetics and imaging.