Perinatal death and damage: predictive and preventive considerations.

The author reviews some of the classical clinical entities which carry with them major degree of risk to the fetus and newborn. He lists systems which facilitate the identification of high risk patients on a statistical basis, and describes easily applied clinical examination techniques which may help in screening and diagnosing previously unrecognized serious problems of feto-placental malfunction.The author then discusses the more sophisticated methods of detecting and managing serious high risk pregnancies, highlighting the severe degree of risk created by the additional stress of labor, superimposed on previous chronic feto-placental malfunction.Dr. Effer concludes that the nature of the sequelae, i.e. death or brain damage, are the product of catastrophic failures; these demand that we consider all the high risk pregnancies with a great deal of respect, and develop increasing cooperative efforts to investigate and institute the already known measures which may create substantial improvement.