Mid trimester miscarriage and premature birth remain a significant cause of perinatal morbidity and mortality presenting an important challenge in perinatal medicine. The place of cervical cerclage requires to be reconsidered and redefined. Insertion of a cervical suture may be useful when there is cervical weakness in a woman at risk of miscarriage or premature birth. Miscarriage is a preferable word to abortion and weakness is a preferable word to incompetence because of the sensitivities of the woman in this situation.

This review will focus largely on the prostaglandins (PGs) in relation to term and preterm birth and highlight some of the newer concepts in this field including the pathways of maternal and fetal PG synthesis, metabolism and receptors. Data from studies in women or from experiments utilizing human gestational tissues will be combined with knowledge gained from animal experiments. An attempt will be made to provide a straightforward, updated view of the role of PGs in these processes. Potential therapeutic strategies for delaying preterm birth and prolonging pregnancy will also be discussed.

Congenital heart disease (CHD) is the commonest congenital malformation with an incidence of approximately 8 per 1000 live births. Half of the defects are severe. Cardiac anomalies at birth are 4 times more common than neural tube defects and 6.5 times more common than chromosomal abnormalities. Within a stillborn population the incidence is approximately 10 times that of live births. Congenital heart disease is responsible for approximately 40% of the perinatal and 60% of post neonatal deaths due to congenital anomalies. Despite screening of the infant population, 30% of cases of CHD are unsuspected or unconfirmed prior to death. Sadly, many of these missed lesions are correctable. However, the overall outlook for CHD is excellent since 85% of infants born with heart malformations will survive into adult life.

Facial clefting is the commonest congenital malformation to affect the head and neck. There are worldwide variations in the incidence of cleft lip and/or palate (CL/P) and cleft palate (CP) but in general they occur in around 1 in 600–800 live births. The diagnosis of CL/P or CP may be missed on mid-trimester screening anomaly scans, as the appropriate facial views may not be required as a routine. In a recent survey of ultrasound departments and with reference to the mid-trimester screening scan, only 50% sought a view of the lips and 25% a view of the palate. Facial clefts may occur as part of a recognised genetic syndrome or chromosomal condition. Structural anomalies associated with such syndromes will prompt a detailed fetal assessment, with greater sensitivity of detection for CL/P and CP than where the defect is isolated. Under such circumstances however, the facial cleft may be less significant than the accompanying abnormalities. Treatment of facial clefts has improved over recent years, not only with advances in surgical care but also with the development of a multidisciplinary approach to ensure that continued care is provided from infancy through to adult life.