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Throughout its prior seven editions, Guidelines for Perinatal Care has
focused on improving the outcomes of pregnancies and reducing maternal
and perinatal mortality and morbidity by suggesting sound paradigms for
providing perinatal care. Its strong advocacy of regionalized perinatal sys-
tems, including effective risk identification, care in a risk-appropriate setting,
and maternal or neonatal transport to tertiary care facilities when necessary,
has had a demonstrable effect on perinatal outcomes. This eighth edition
expands the regionalized care concept further by describing levels of mater-
nal care in detail in Chapter 1. Although a national dialogue about matching
levels of hospital care to levels of care required for mothers and neonates
has been ongoing since the publication of the March of Dimes Foundation’s
Toward Improving the Outcome of Pregnancy in the 1970s, this concept has
only truly been implemented consistently for neonates. In Chapter 1, you
can see that the American College of Obstetricians and Gynecologists and
the American Academy of Pediatrics now believe it is time to demand such
levels for mothers as well. We present the suggested level of maternal care
from birth centers to a described level IV institution. This edition also makes
evidence-based recommendations on the use of safe and effective diagnostic
and therapeutic interventions in maternal–fetal medicine and neonatology.
The full spectrum of high-quality perinatal care is covered by this eighth
edition of Guidelines for Perinatal Care, from the principles of prepregnancy
counseling and the provision of antepartum and intrapartum care in routine
and complex settings to guidelines for routine and complex neonatal and
postpartum care. The prepregnancy and antepartum care chapters introduce
the concept and underscore the importance of interpregnancy care to mater-
nal and fetal health. Chapter 5 from the seventh edition has been split into
two chapters one of which includes prepregnancy and interpregnancy care,
and the other of which covers antepartum care. We also have added sections
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Introduction
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