UPDATE ON OBSTETRICS

The drive to do more and do it faster continues, leading to notable advances in prenatal diagnosis and fetal therapy, but is not sustainable over the long term

Dr. Pauli is Assistant Professor, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Penn State University College of Medicine, and Attending Perinatologist at The Milton S. Hershey Medical Center in Hershey, Pennsylvania.

Dr. Repke is University Professor and Chairman of Obstetrics and Gynecology at Penn State University College of Medicine. He is also Obstetrician-Gynecologist-in-Chief at The Milton S. Hershey Medical Center in Hershey, Pennsylvania. He serves on the OBG Management Board of Editors.

The authors report no financial relationships relevant to this article.

If there have been overriding themes in obstetrics over the past year, they have been “more,” “sooner,” “faster,” “safer.” Advances in our field have thrilled our scientific curiosity and increased our ability to alleviate suffering—but at what cost? And who will pay that cost?

In this Update, we focus on recent advances in prenatal diagnosis and fetal therapy, as well as the ever-encroaching economic barriers that may limit our ability to get what we want. In particular, we will discuss:

• two technologies in prenatal genetics: noninvasive aneuploidy testing using cell-free DNA and prenatal microarray analysis

• open fetal surgery to reduce mortality and improve the function and quality of life for fetuses with open neural tube defects

• the value and probable impact of bundled payments—that is, one payment for multiple services grouped into one “episode.”