The cardiovascular system undergoes remarkable adaptive changes in pregnancy. Through a complex network of interrelated pathways the physiological response to the conceptus ensures an adequate blood supply and oxygen gradient to meet the demands of the feto-placental unit whilst maintaining normal maternal blood pressure. This is achievable because the increase in maternal cardiac output and blood volume which characterise normal pregnancy occur with an associated and profound decrease in peripheral vascular resistance. Longitudinal studies using Doppler ultrasound and echocardiography indicate that the decline in peripheral vascular resistance occurs very early and data from the pregnant baboon and pregnant women suggest that this is the stimulus which activates the renin-angiotensin aldosterone axis and the resultant rise in plasma volume.

Early this century, the term cytomegalic inclusion disease (CID) was used to designate the cellular changes characterized by enlargement and typical intranuclear inclusions observed in tissues of fetuses and infants with a fatal illness. In 1957, Smith and Weller et al, identified the causative agent of CID, which was named cytomegalovirus (CMV) by Weller in 1960. By 1971, it was clear that congenital human CMV (HCMV) infection was an important health problem. Since then, many advances have been made in the diagnosis, therapy, and knowledge of the epidemiology of congenital HCMV infection. However, most of these improvements, particularly those concerning diagnostic technologies and development of antiviral drugs, have been the result of the powerful effort to reduce the devastating impact of HCMV infections in AIDS and transplanted patients. Indeed, it is disappointing to observe that in the year 2000 CID does still occur, that HCMV is still recognized as the leading cause of congenital infection and the leading infectious cause of mental retardation and deafness, and, most important, that no active prevention is available for seronegative women. Moreover, because of the limited possibilities of prophylaxis and treatment, and the misuse of the currently available serologic assays, the issue of whether the determination of HCMV antibody status for women of childbearing age is justified has become a matter of debate.

The uterine cervix is a remarkable structure, which plays an essential role in pregnancy. During the development of the conceptus within the uterus, the cervix usually remains firmly closed to ensure that the developing fetus attains an appropriate degree of maturity to permit extra-uterine survival. On the other hand, it prepares for labour and birth, by undergoing a process of effacement, whereby the substance of the cervix shortens and thins out. During labour, it must be stretched and dilated to a sufficient diameter, usually about 10cm at term, to allow the successful passage of the fetus through the birth canal.

Cerebral Palsy (CP) describes a group of permanent non progressive but often changing neurological impairement syndromes as assessed at 3 and 5 years of age. The term includes serious motor disorders including spastic diplegia (Little syndrome), hemiplegia and quadriplegia associated with neuropsychological seizures and cognitive impairment due to permanent damage to the immature brain. Fifty percent of CP cases are premature neonates and 25% are very severely premature. There is a significant correlation between CP and brain lesions in the neonatal period among which periventricular leukomalacia (PVL) is the most common.

Some babies are hypoxic at birth, yet suffer no ill effects, whilst others have a poor prognosis. To understand why this is so, we need to consider the factors that determine fetal oxygen supply and how the fetus copes with any decrease in oxygen delivery.

Human milk contains a unique mixture of nutrients that meet all the nutritional requirements of the growing infant for the first few months of life. Furthermore, it provides bioactive, non-nutritional substances including anti-microbial and anti-inflammatory factors, growth factors, cytokines, hormones and digestive enzymes which confer protection from bacterial and viral infections, and may aid growth and development of the newborn.