NZ Research helps difficult pregnancies

Before the 1960's knowledge of the intrauterine environment was like a black box, limiting clinical understanding, and monitoring of the fetus during pregnancy. Little was known about the fetus until after birth happened. Now that has changed dramatically, and there have been revolutionary advances, particularly in the last 20 years enabling clinicians to diagnose and treat problems which develop in the womb.

Professor Pippa Kyle, the recently appointed head of Obstetrics and Gynaecology at the Christchurch School of Medicine and Health Sciences, Otago University, will discuss these significant improvements in Maternal and Fetal Medicine in her Professorial Inaugural Lecture on Wednesday April 14 at 7.30pm. The lecture, ÒThe developing fetus. When can problems occur and how can we intervene?Ó is part of the current Health Lecture Series and is open to the public.

As the South Island's first specialist in Maternal and Fetal Medicine,Professor Kyle brings wide expertise to her role in diagnosing and managing difficult or abnormal pregnancies at Christchurch Women's Hospital. Previously she worked in a similar role as Consultant Obstetrician and Director of the Fetal Medicine Unit in Bristol, UK, and lectured at the University of Bristol. Her initial medical education was at the University of Auckland, followed by research and higher training in Oxford, Cambridge and London.

Professor Kyle's Inaugural Lecture outlines the major advances in fetal medicine over the last twenty years; the development of ultrasound, the understanding of fetal physiology, neonatal medicine, DNA technology and the genetic revolution, and the fetal origins of adult disease. She then focuses on a number of critical areas where complications can arise that once may have resulted in serious complications or miscarriage.

She discusses possible complications which can arise in multiple pregnancy and says that normal outcome in the case of twins is dependent on whether there are one or two placentas. Today this can be determined through ultrasound before 14 weeks, and managed accordingly.

Chromosomal abnormalities, linked to conditions such as Down's syndrome, are more common with older mothers, but today these too can be diagnosed early by non-invasive methods. However, invasive testing such as aminiocentesis and fetal blood sampling may still be necessary, although research done by Professor Kyle in the UK shows these tests carry a low rate of miscarriage when performed by a skilled clinician.

Other areas Professor Kyle will discuss are the use of ultrasound in detecting physical abnormalities, and the dramatic improvements in diagnosis of fetal anaemia through Doppler ultrasound and genetic testing. All these developments mean much improved neonatal outcome in problematic pregnancies, and point to continuous advances in this exciting area of medicine.