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UNTIL very recently fetal cardiology was restricted to the study of the embryology of the fetal heart with the primary emphasis on the understanding of the development of structural congenital cardiac abnormalities. Cardiology, and in this sense pediatric cardiology, started with the birth process and was again primarily directed toward recognition, diagnosis, and therapy of neonatally recognized structural congenital heart problems. During the last decade, the fetal heart has attracted increasing interest both on the part of the obstetrician-perinatologist and the pediatric cardiologist. Research into the developing heart has concentrated on embryology but has covered such important areas as the biophysics of the developing heart, the autonomic control of fetal cardiac activity, as well as genetic, infectious, metabolic, and environmental causes for congenital heart abnormalities. The advances and the understanding of basic physiology of the fetal heart as well as the development of newer diagnostic means have, in turn, improved

The article by Frigoletto et al, appearing elsewhere in this issue (p 2496), is perhaps the vanguard of pioneering efforts at invasive care of the fetus. The precedent was set almost 20 years ago by Liley, 1 who described successful intrauterine transfusion for severe erythroblastosis. Intrauterine transfusion never became commonplace because Rho(D) immune globulin greatly reduced the number of severely sensitized Rh-negative mothers. However, it has achieved an accepted place in the therapeutic armamentarium. Frigoletto et al report intrauterine diagnosis of hydrocephalus, with percutaneous placement of a ventriculoamniotic shunt under ultrasound guidance. The shunt decompressed the ventricles and allowed pregnancy to continue to a point where a viable newborn was delivered. That the baby later died of probably unrelated causes does not obscure the fact that the feasibility of intrauterine decompression of progressive hydrocephalus was established. While the article further demonstrates the accessibility of the fetus to transabdominal manipulation, it

The Prenatal Diagnosis of Hereditary Disorders by Dr. Aubrey Milunsky was expressly written for physicians, counselors, and other medical personnel who are in a position to counsel families at risk for a variety of genetic disorders. The content of the book is more general than that suggested by the title. The author has had extensive experience with intrauterine diagnosis since the late 1960s and reviews his experience, as well as that of others, relating to prenatal diagnosis. In addition, sections on genetic counseling, genetics and society, and morality, ethics, law, and the future are included. The text is, in general, easy to read, highly accurate, and provides an excellent review of the field up to the time that it was written. The data on amniocentesis are accurate and the experience is reviewed in great detail. The entire text is easily understandable and certainly answers the overwhelming majority of questions

In the ten chapters selected topics of developmental biochemistry are presented by 14 well chosen authors. Sereni and Principi tackled the complicated question of how perinatal liver function is regulated; the authors collected valuable information on this relatively new and little explored topic. A very impressive achievement in intrauterine diagnosis and antenatal detection of inherited diseases is presented by Nyhan who excellently surveys the great number of biochemical disorders with didactic skill. The complicated and complex regulation of genetic expression is described by Benson. This author who also edited the book discusses the ten principal factors involved in protein synthesis, the programmed differential expression of the genome, and the biosynthesis and control of RNA and protein. Walker surveys the development of enzymes for carbohydrate metabolism; he stresses the importance of control mechanisms and rate-controlling enzymes in the perinatal period. The developmental aspects of lipid metabolism are described by Myatt; the