Prenatal care reduces the impact of illicit drug use on perinatal outcomes. Women who misuse substances are often excluded from mainstream society and, on becoming pregnant, feel guilty about their drug misuse and the potential effects this could have on their unborn baby. These women are vulnerable in many ways and agencies must ensure that they are not excluded from antenatal care. The latest enquiry into maternal deaths published in the UK (CEMACH report) highlights how women with socially complex lives who died were far less likely to have sought antenatal care early in pregnancy or to remain in regular contact with maternity services. Of the women who died from any cause, 11% had problems with substance abuse of whom 60% were registered addicts. Gaps in communication between agencies was highlighted as a particular problem.

Type 1 diabetes complicates around 1 in 200 to 300 pregnancies in the United Kingdom. Historically maternal type 1 diabetes carried very high risks for mother and child. Introduction of insulin led to an immediate, marked decline in the previously very high rates of maternal mortality; in contrast an improvement in perinatal outcomes occurred more slowly but was nevertheless dramatic. This is strikingly demonstrated by the temporal decline in perinatal mortality in offspring of mothers with type 1 diabetes which was virtually universal before use of insulin in the 1920's, likely remained in excess of 20% even in the 1960's and fell to under 4% by the 1990's. The reasons for this more gradual improvement in perinatal outcomes cannot be defined with precision but will have been influenced by improved glycaemic management with use of intensive, multiple dose insulin treatment and home glucose monitoring; improvements in obstetric and neonatal management, and better management of complications of diabetes before and during pregnancy. In 1989 the St Vincent declaration proposed that pregnancy outcomes in women with type 1 diabetes should approximate those of the non-diabetic population. While the long term improvements in fetal outcomes have been dramatic, contemporary surveys confirm a persistent doubling or more of rates of congenital anomaly and a three to four fold increase in perinatal mortality in the UK and other European countries which will require further clinical innovation to overcome.

The topic of pelvic floor assessment is increasingly attracting attention from gynaecologists, colorectal surgeons, urologists and physiotherapists. This is not surprising, many women who have given birth naturally are affected by pelvic floor trauma, and so are their partners. Health professionals deal with the eventual consequences of such trauma, especially pelvic organ prolapse and faecal incontinence.

Parturition is the process leading to expulsion of the fetus from the uterus. It is the result of a co-ordinated interplay between maternal and fetal factors. Despite extensive research the mechanisms that control the length of human pregnancy and signal the onset of labour remain unknown. Preterm labour refers to the onset of labour before 37 completed weeks or 259 days of pregnancy and after the gestation of viability (20–25 weeks, depending on definition). In most developed countries, preterm birth occurs in 5–10% of pregnancies whereas this may rise to 25% in certain developing countries. Despite advancing knowledge of risk factors and the introduction of beneficial medical and public health interventions the incidence of preterm birth rate has risen over the last two decades. Preterm birth is the single biggest cause of perinatal mortality. Adverse outcomes for the neonate include respiratory complications, necrotizing enterocolitis, sepsis and neurodevelopmental disorders. Among those babies born before 30 weeks who survive, approximately 25% will have a major disability. Another 10% will have some disability and an additional 30% will have cognitive, perceptual and behavioural problems that could interfere with school performance. The consequences of prematurity are not confined to the neonate but have important long-term social, financial, behavioural and educational implications.