[Review, present and prospects of obstetrics].
During the last 25 years, the most impressive development in obstetrics has been the reduction of perinatal mortality from approximately 25 to below 6. Contrary to the expectations of those days, this has not been achieved by a decreased rate of premature births but by a better management of prematurely born babies, particularly by the induction of fetal organ maturity by corticosteroids and the antenatal transfer of high-risk pregnant women to a perinatal care centre. A more careful birth management and the corresponding ameliorations in neonatology (e.g. dosing of surfactants, less invasive methods of artificial respiration) have also contributed to the better results. The introduction of the prostaglandins to expel the fetus, the induction of delivery treatment of postpartal atonia were other milestones in the of obstetrics. Apart from these medical developments, sociological trends shaped obstetrics too, and these will influence it future: the increasing importance of the patient's will, paramedical factors in obstetrics and the heightened readiness to go to court in case of supposed damage. In obstetrics, the next few decades will show an uncheckable increase in the frequency of caesarean sections, due to - among other factors - the knowledge that vaginal deliveries cause injuries of the pelvic floor which have mostly been disregarded until now. Because of the expected decrease in birth rates, the increased number of doctors and midwives, the more and more demanding attitude of the population and the relentless readiness of supposedly injured patients to take legal action, the environment for obstetricians well become even more difficult in the future.
D001317:Austria; D002585:Cesarean Section / Q000639:trends; D005260:Female; D005544:Forecasting; D049673:History, 20th Century; D006801:Humans; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D009359:Neonatology / Q000639:trends; D009774:Obstetrics / Q000266:history / Q000639:trends*; D011247:Pregnancy; D011453:Prostaglandins / Q000627:therapeutic use; D015145:Tocolysis / Q000639:trends