Prevention programmes against Rh alloimmunization are now so widespread as to be universal in the developed world. Accordingly, there has been a dramatic decline in the incidence of fetal anaemia secondary to this cause, along with relative growth in the importance of alloimmunization due to other antibodies, particularly Kell. Antibodies to the Kell group of antigens, in particular K1, can cause profound fetal anaemia leading to hydrops and fetal demise unless appropriate and timely intervention is undertaken.

Within the human placenta the villous trophoblast represents the epithelial covering of the chorionic villi. This layer of trophoblast actively participates in transport processes between mother and fetus and is the surface of the barrier separating maternal and fetal blood. It represents the main site of metabolic and endocrine activities of the placenta. It is comprised of an outer continuous layer without cell borders, the syncytiotrophoblast, beneath which resides a population of proliferating cytotrophoblast cells. Daughter cytotrophoblast cells fuse into the syncytium, while aged nuclei inside syncytial fragments are shed into the maternal circulation (Figure 1). Any process disturbing the balance between proliferation, syncytial fusion or shedding will alter the integrity and function of the layer as a whole, which in turn may impair gas and/or nutrient transfer to the fetus as well as endocrine activities. Trophoblast turnover is thus tightly regulated to ensure normal fetal development.

Routine electronic fetal heart rate monitoring has been associated with a significant reduction in fetal mortality and early onset neonatal seizures. However, the positive predictive value of changes in the fetal heart rate pattern is very low, and thus there has been a disproportionate increase in the rates of operative intervention in labour, compared with very modest reductions in neonatal encephalopathy. Recent studies have demonstrated that postasphyxial encephalopathy in term babies now derives almost entirely from low and medium risk pregnancies. This suggests that the current model of obstetric care is very effective in high-risk populations. However, further improvements in the care of what are now generally low risk patients will require simple, widely applicable strategies for detecting the infant at risk of asphyxial complications.

Musculoskeletal complaints are a common source of antenatal and peripartum morbidity, yet are frequently dismissed by healthcare professionals. Although increasing pelvic laxity is thought to be physiological as pregnancy advances, a number of women develop pain and disability out of proportion to the degree of joint distension. The term ‘symphysis pubis dysfunction’ is one of the many used to describe the constellation of typical symptoms and signs. (Table 1) The first formal documentation of the condition is accredited to Snelling in 1870. “The affection appears to consist of a relaxation of the pelvic articulations, becoming apparent suddenly after parturition, or gradually during pregnancy; and permitting of a degree of mobility of the pelvic bones which effectively hinders locomotion, and gives rise to the most peculiar, distressing and alarming sensations.” Although dated his description still provides a succinct description of the condition.