Pediatricians, as primary care physicians and as subspecialist neonatologists, consult and work collaboratively with obstetric providers in preconception counseling, fetal risk identification, and peripartum decisions. They assume primary responsibility for resuscitation, stabilization, and ongoing care of the neonate from the moment of birth. Years ago, pediatricians first saw their newborn patients in the nursery, but only after the events of pregnancy and delivery.

Knowledge of fetal health includes appreciation of the interaction of the fetus with the mother, father, health professionals, and society. Now, many examples exist of the ability of fetal medicine, as part of preconception and prenatal care, to prevent or treat problems and to improve outcomes.

Parents and professionals have good reason to be concerned about the immediate and long-term effects of agents or processes on the fetus. Infections such as rubella can result in the loss of the fetus or in multisystem disease. The magnitude and seriousness of manifestations of maternal alcohol consumption, tobacco use, or substance abuse during pregnancy may be evident in the infant's physical appearance or behavior in the neonatal period and throughout the infant's life span. Furthermore, problems may not appear until a subsequent generation. The effects of diethylstilbestrol, once given to mothers for threatened abortion, did not present until the appearance of clear cell carcinoma of the vagina in female offspring 10 to 20 years later.[1]

Growth and development are as much a key to fetal medicine as they are to pediatrics, of which study of the fetus is merely the first installment. Human growth and development must be regarded as a continuum that begins with conception (Figure 73-1). This chapter outlines some of the normal physical and interactive aspects of fetal existence, then discusses selected pathophysiological states that may adversely affect that existence.