Fulcheri E, Bulfamante G, Resta L, Taddei G L
DiCMI, Sezione di Anatomia Patologica, Università di Genova, Italia.
Pathologica. 2006 Feb;98(1):1-36.
The Authors have focused on the most important feto-neonatal and placental diseases in order to develop modern diagnostic tools which can meet the needs of clinicians (obstetricians, gynecologists, and neonatologists) for the best possible management of both the mother and the newborn. Although far from being operational instructions, it should be intended as a programmatic document providing a guideline on the issues that have cropped up in eight years of work of the APEFA group, as well as during several residential and practical classes. First of all, a synopsis is provided of the main issues concerning placental diagnosis in the newborn, as well as in case of fetal loss. A reasoned review is then provided of the main diagnostic criteria in placental pathology, in the light of therapeutical measures toward the mother (monitoring of future pregnancies) and the newborn (management of newborns at risk or with infectious disease). Legal issues in case of fetal distress at the end of pregnancy, neonatal damage and peripartum death have also been discussed with particular attention. Early and late miscarriages have also been separately examined, as well as fetal deaths. For each of these categories, a critical analysis is presented of current issues, followed by some considerations on the development of diagnostic methods and technology, and a modern diagnostic process is then outlined. Reference tables are also provided for diagnostic, auxological parameters, as well as on essential procedures. Issues concerning legal abortions and terminations of pregnancies have also been considered, with particular reference to tests and supplemental genetic and ultrasound examinations, diagnostic questions about malformations and forensic medicine assessments that are often involved with these specific categories. Malformations, fetal distress and growth retardation, sudden fetal and neonatal death, as well as embryo-pathology are all briefly dealt with also with synoptic tables. Diagnostic criteria are thus optimized and specially aimed at solving "human reproduction pathology" issues.
作者聚焦于最重要的胎儿 - 新生儿及胎盘疾病，以开发现代诊断工具，满足临床医生（产科医生、妇科医生和新生儿科医生）对母婴进行最佳管理的需求。尽管远非操作指南，但应将其视为一份纲领性文件，为APEFA小组八年工作以及多次住院和实践课程中出现的问题提供指导方针。首先，概述了新生儿胎盘诊断以及胎儿丢失情况下的主要问题。然后，根据对母亲（监测未来妊娠）和新生儿（管理高危或患有传染病的新生儿）的治疗措施，对胎盘病理学的主要诊断标准进行了合理回顾。还特别关注地讨论了妊娠末期胎儿窘迫、新生儿损伤和围产期死亡的法律问题。早期和晚期流产以及胎儿死亡也分别进行了研究。对于这些类别中的每一个，都对当前问题进行了批判性分析，随后对诊断方法和技术的发展进行了一些思考，并概述了现代诊断过程。还提供了诊断、生长发育参数以及基本程序的参考表。还考虑了与合法堕胎和终止妊娠相关的问题，特别是涉及检测以及补充基因和超声检查、畸形诊断问题以及这些特定类别中经常涉及的法医学评估。畸形、胎儿窘迫和生长迟缓、胎儿和新生儿猝死以及胚胎病理学也都通过一览表进行了简要处理。诊断标准因此得到优化，特别旨在解决“人类生殖病理学”问题。
