By Sergio Fabro, Anthony R. Scialli (auth.), Harold Kalter (eds.)

There remains to be no transparent knowing of what explanations the good majority of human congenital malformations. and because in so much types of human affliction and pathology that but succeed prevention frequently awaits realizing of reason, it truly is regularly idea that an identical is correct of developmental aberrations. yet is that this real? For the rather few congenital malformations whose motives are basically environmental, it really is undeniable that their discovery has enabled prevention, yet no longer nec­ essarily instantly. It took a iteration from the time of the invention that maternal rubella used to be teratogenic to benefit tips on how to immunize opposed to it. a lot debate happened ahead of it was once preferred that thalidomide was once a teratogen, and in simple terms its elimination from the pharmacist's shelf and the tip of the epidemic of limb defects attributed to the drug overcame the final doubts. For different confirmed environmental teratogens doubts and problems nonetheless con­ tinue. The claimed incidence of fetal genital distortions as a result of girl intercourse hor­ mones can have been exaggerated. a few most likely teratogenic healing medicinal drugs, like anticoagulants, anticonvulsants, and anticancer chemical substances, are nonetheless pre­ scribed regardless of this possibility due to their merits to pregnant ladies. For these congenital malformations whose foundation is predominantly genetic or chromosomal it's varied, notwithstanding. Prevention has now not been accomplished via the invention of such reasons, as dramatic and innovative as a few of them were, other than within the questionable experience of interference with replica via genetic coun­ seling or prenatal removal. yet this has no longer inhibited the romanticists.

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N. Engl. I Med. 308:424-431, 491-497. Kerenyi, T. , and Chitkara, U. 1981. Selective birth in twin pregnancy with discordancy for Down's syndrome. N. Engl. I Med. 304:1525-1527. Kidd, V. , Golbus, M. , Wallace, R. , and Woo, S. L. C. 1984. Prenatal diagnosis of alphat-antitrypsin deficiency by direct analysis of the mutation site in the gene. N. Engl. I Med. 310:639-642. Little, D. , and Campbell, S. 1980. The diagnosis of spina bifida and intracranial anomalies, in: The Principles and Practice of Ultrasonography in Obstetrics and Gynecology, R.

I Med. 310:1018-1022. Huhta, J. , Hagler, D. , and Hill, L. M. 1984. Two-dimensional echocardiographic assessment of normal fetal cardiac anatomy. I Rep rod. Med. 29:162-167. Jeppsson, J. , and Gustavii, B. 1979. Prenatal exclusion of alpha-i-antitrypsin deficiency in a high risk fetus. N. Engl. I Med. 300:1441. Jones, H. , Acosta, A. , Andrews, M. , Garcia, J. , Jones, G. , Sandow, B. , Whibley, T. , Wilkes, C. A. and Wright, G. L. 1983. What is a pregnancy? A question for programs of in vitro fertilization.

The author currently uses a classification based on the morphology and pathology of the placenta (Rushton, 1978) rather than of the embryo or fetus, although abnormalities of the latter are recorded. Three major groups are recognized: I. 4 weeks. II. 1 weeks. III. 6 weeks. In an un selected population approximately two-thirds of cases will fall into groups I and II, the remainder into group III or an unclassifiable category. It is 23 24 D. I. RUSHTON not unreasonable to expect that the majority of very early abortions detected by ultrasound or endocrinologically will fall into group I.

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