Improvements in anaesthetic care and postoperative management over the last two decades have significantly improved survival of neonates with ventral abdominal wall defects, from a dismal 47% in 1971, to 96% for both gastroschisis and isolated omphalocele in two recent series. This increased survival has generally been attributed to result from improvements in the pre and postoperative management of these fragile neonates. Specifically, the routine use of total parenteral nutrition, and staged repairs for cases with severe “viscero-abdominal disproportion” have been implicated in a decreased incidence of sepsis, morbidity and mortality. In addition, an appreciation of the wide spectrum of anomalies uniquely associated with gastroschisis and omphalocele have helped improve survival, as each has unique pathophysiologic features that have prognostic implications for the fetus before, during and after delivery.

Behaviour originally depends on precise and specific interconnections between nerve cells. The nervous system itself develops in a series of appropriately timed steps with a temporal sequence characteristic of each neural structure.

In pregnancies complicated by severe red cell alloimmunization, fetal haemolytic anaemia can lead to intrauterine demise as early as 17 weeks' gestation. Intrauterine intraperitoneal blood transfusion, introduced by Liley in 1963, proved to be the first successful example of fetal therapy. The use of this complex procedure, involving X-ray guided puncture of the fetal peritoneal cavity, was limited to fetuses with a gestational age ranging from 24 to 33 weeks. When performed below 26 weeks, survival rates were as low as 16%. The need for intrauterine transfusion was mainly based on determination of bilirubin levels in amniotic fluid, and plotting the results in a three-zone chart devised by Liley. This chart was based on correlations of amniotic fluid bilirubin concentrations with the degree of neonatal anaemia, and ranged from 27 to 41 weeks' gestation. In the 1980s, with the introduction of ultrasound-guided intravascular transfusion, treatment became possible from 17–18 weeks' gestation onwards. Consequently, there was a need for diagnostic tests to assess the degree of anaemia in the second trimester fetus. The use of the Liley chart was shown to be unreliable in the prediction of disease severity before 27 weeks' gestation. Ultrasonographic detection of fetal hydrops in these pregnancies reliably indicates severe anaemia, but for reasons that are still unclear, a significant number of severely anaemic fetuses do not show ultrasonographic signs of hydrops. In 1988, Nicolaides et al studied the use of several ultrasonographic parameters to predict anaemia in nonhydropic fetuses. Their results were disappointing, and they concluded that the only reliable diagnostic test to assess the degree of fetal disease was fetal blood sampling.

Deoxyribonucleic acid (DNA) is composed of a deoxyribose backbone, the three position (3') of each deoxyribose being linked to the five position (5') of the next by a phosphodiester bond. At the two position each deoxyribose is linked to one of four nucleic acids; the purines adenine or guanine or the pyrimadines thymine or cytosine. Each DNA molecule is made up of two such strands in a double helix with the nucleic acid bases on the inside. The bases pair by hydrogen bonding, adenine (A) with thymine (T) and cytosine (C) with guanine (G). Deoxyribonucleic acid is replicated by separation of the two strands and synthesis by DNA polymerases of new complementary strands. With one notable exception, the reverse transcriptase produced by viruses, DNA polymerases always add new bases at the 3' end of the molecule. Ribonucleic acid (RNA) has a structure similar to that of DNA but is always single stranded. The backbone consists of ribose, and uracil is used in place of thymine.