For obstetrical providers ro bener deal with opioid-addicted pregnant women and their fetus-newborns, the Eu.nice Kennedy Shriver National Institute of Child Helth and Human Development convened a workshop in 2016 co study many aspecrs of the problem (Reddy. 2017). he Workshop was cosponsored by the American College of Obstetricians and Gynecologisrs, the American Academy of Pediatrics, the Society for Maternal-Fetal Medicine, the CDC, and the March of Dimes. Several copies were addressed, and hopefully implementation of these indings will help improve maternal treatment and neonatal outcomes (American College of Obstetricians and Gynecologists. 2017a).
The bold new concept of in-vitro fercilization (IVF) produced the irst IVF baby in Britain in 1978. This was soon followed in 1981 with an American success. After four decades. the Society for Assisted Reproductive Technology (SART) reports that more than 1 million babies have been born in the United States using assisted reproductive technologies (ART) ofered by 440 clinics (Fox. 2017).
ter IS years of experimental preparation. the promise of a successful human uterine transplant was finally realized with n
Overview of Obstetrics 9
IVF-conceived livebon neonate in Sweden (Brinnstrom, 2015).
During pregnancy, the mother was treated with t:lcrolimus, azathioprine, and corticosteroids and underwent cesarean delivery at 32 weeks for preeclampsia and abnormal feral heart rate testing. This was followed by uterine trmsplamation programs at the C1cvebnd Clinic and Baylor Medical Center in Dallas (F1yckt. 2016. 2017, Testa. 2017). In 2017. the Swedish team had completed a nine-patient trial, in which seven women had become pregnant and ive had sllccessful deliveries (Kuehn, 2017). Also, in Dallas, the irst such newbon in the Unired Stares was born (Rice. 2017).
Meanwhile, researchers at Children's Hospital of Philadelphia pursued a 20-year goal in search of an artiicial womb (Yuko, 2017). Using incubatOr technology, [he team devised an artiicial amnionic sac. hrough this, (he umbilical vessels were perfused and drained, and the blood was retuned to systems [hat performed exrracorporeal membrane oxygenation and dialysis. To date, lamb fetuses have been kept alive for as long as 1 month. Adverse efects of cerebrovascular hypotension and hypoxemia are conjectural but highly worrisome.
1he ethical and legal challenges of these new technologies are daunting. Of those that arose from IVF, mOSt are setded. For the Q[her twO endeavors, there are likely many years of ethical and legal milestones ahead.
American Academy of Pediatrics, American College of Obstetricians and Gynecologisrs: Guidelines for perinatal care, 8th ed. Elk Grove Village, AAP,e2017
American College of Obstetricians and Gynecologists: Coping with the stress or medical profeSSional liabiliry litigation. Committee Opinion No. 551, January 2013, Reairmed 2016a
American College of Obm=tricians and Gynecologists: Deinition of term pregnancy. Comminee Opinion No. 579, November 2013, Reairmed 2016b
American College of Obstetricians and Gyneologists: Disclosure and discussion of adverse events. Committee Opinion No. 681, December 2016c
American College of Obstetricians and Gynecologists: Prediction and prevention of preterm birth. Practice Bulletin No. 130, October 2012, Reairmed 2016d