Evolution of instrumental diagnostic methods
For many years, an objective assessment of the developing child's condition posed a serious challenge. A breakthrough came with the sequential introduction of instrumental methods:
- Phonocardiography and electrocardiography (ECG). These technologies became historically the first methods for the objective recording of fetal cardiac activity.
- Cardiotocography. Their advent made it possible to continuously record the instantaneous heart rate. Thanks to this, doctors learned to distinguish normal cardiac activity from signs of oxygen deprivation (hypoxia) in real time.
- Ultrasound examination (US). The introduction of sonography brought a true revolution to the specialty. For the first time, it became possible to perform visual dynamic monitoring of the embryo and placenta. Ultrasound paved the way for a detailed study of the pathophysiological processes of the fetal period, the development of intrauterine therapy methods, and evidence-based management of complex pregnancies.
The rise of perinatology
After World War II, developed countries faced a sharp decline in birth rates. Under these conditions, the life and health of every child, including those born prematurely, acquired the highest value.
In the early 1970s, European scientists initiated the creation of perinatology—an independent branch of medicine focused on fetal and neonatal health protection. The official establishment of the new discipline took place in 1973 in Moscow, during the World Congress of Obstetricians and Gynecologists.
The rapid development of perinatology required the introduction of a unified terminology worldwide. The emergence of such standardized concepts as "perinatal mortality" made it possible to objectively compare the outcomes of doctors' work in different countries and actively exchange clinical experience.
Structure of the Perinatal Period
The word "perinatology" itself has a mixed origin. It is formed from the Greek peri ("around"), the Latin natus ("related to birth"), and logos ("science/study"). The perinatal period is traditionally divided into three sequential stages:
- Antenatal — the prenatal stage.
- Intranatal — the labor process itself. This period requires particularly careful diagnostic monitoring of the fetal vital signs.
- Postnatal — the first 7 days of the infant's life.
The intranatal and postnatal time frames have historically been stable, whereas the boundaries of the antenatal period have undergone significant changes. Previously, it was calculated from the 28th week, when the fetal weight reached 1,000 grams (this threshold separated delivery from abortion). Today, in most developed countries, thanks to advances in preterm infant care, the antenatal period begins from the 22nd–23rd week, upon reaching a body mass of 500 grams. The time prior to this critical milestone is called the prenatal period.
International protocols and standards
Modern practice relies on strict international guidelines regulating the physician's actions in critical situations:
- EAPM Recommendations (2017). The document of the European Association of Perinatal Medicine outlines the basic management tactics for spontaneous preterm labor (Preterm Labor).
- ISUOG Practice Guidelines (2022). The guideline of the International Society of Ultrasound in Obstetrics and Gynecology. It emphasizes the critical role of ultrasound examination, specifically cervicometry, in predicting the likelihood of spontaneous preterm birth.
Contribution of national specialists
The formation of fundamental knowledge in obstetrics would have been impossible without prominent national figures in science. Their classical works, textbooks, and methodical manuals remain relevant today.
Among the key figures of the Moscow school are V.I. Bodyazhina, K.N. Zhmakin, I.F. Zhordania, N.A. Tsovyanov, and L.V. Vanina. In Leningrad, an enormous contribution was made by M.A. Petrov-Maslakov, I.I. Yakovlev, and S.M. Bekker. The Kiev school is represented by the works of A.P. Nikolayev, A.S. Baksheyev, and L.V. Tymoshenko. A significant role was also played by I.I. Grishchenko in Kharkov and K.V. Chachava in Tbilisi.
The perinatal period is easy to remember by the acronym AIP: Antenatal (before), Intranatal (during), Postnatal (after). The modern boundary of the antenatal stage is the "rule of twos and fives": 22–23 weeks and 500 grams.
Class and exam questions
Why have the boundaries of the antenatal period changed?
In the past, the boundary between a late miscarriage and delivery was considered to be 28 weeks and a mass of 1,000 g. Today, the survival of infants at much earlier stages has been proven, so the threshold has been lowered to 22–23 weeks and 500 grams.
What served as the impetus for the creation of perinatology?
The historical prerequisite was the decline in birth rates in developed countries after World War II. This led to the realization that the life and health of absolutely every newborn are of immense value.
How are the 2022 ISUOG recommendations related to ultrasound?
This international document defines the role of ultrasound scanning (primarily the assessment of the uterine cervix) for the accurate prediction of the risk of spontaneous preterm birth.
What else to study on this topic
- Cervicometry according to ISUOG protocols: technique and clinical significance
- Signs of intrauterine hypoxia on the cardiotocograph
- Management tactics for premature rupture of membranes
- Features of the postnatal period: newborn adaptation
- Criteria for perinatal mortality and international statistics
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