When routine becomes extraordinary: meeting the challenge.(The Master Class)

Obstetrical cases almost always end happily--so routinely that patients may come to view the births of their children as risk-free milestones in their family histories. As obstetricians, we know better. Only to the unpracticed eye could what we do be described as "just delivering babies."

We realize that even a low-risk pregnancy can quickly, sometimes subtly, become a high-risk pregnancy, beset with complications that can have unfortunate outcomes. We also increasingly see patients whose pregnancies are high risk at the onset, most often because of medical problems that predated gestation.

OB. GYN. NEWS has long earned a reputation for being a vital source for practitioners seeking vignettes and pearls, reports of cutting-edge research, and general guidance for routine practice. However, several fellow advisers and I have come to believe that in today's world, you also need to find on these pages a column addressing more perplexing and complex issues.

That's why we've introduced "The Master Class." Here we will address the management of pregnant patients who have all manner of preexisting illnesses and conditions, from valvular heart disease to diabetes, from obesity to HIV. We will demystify the rapidly evolving fields of biochemical markers and imaging for prenatal diagnosis earlier and earlier in pregnancy. "The Master Class" will explore high-risk situations in presumed low-risk patients, always striving to present a perspective that is accurate, complete, and applicable to the real challenges we all face on occasion in our practices.

I will serve as a coeditor of this column, focusing on obstetric topics. My fellow coeditor, Dr. Charles Miller of the University ...