Group B streptococcal disease is the commonest cause of early-onset neonatal sepsis in most developed countries. Recent epidemiological studies and controlled trials have shown that many cases are theoretically preventable and guidelines have been widely adopted in the United States and Australia but are not common place in much of Europe. Infections caused by group B streptococcus may present at any time before, during or after delivery. This article reviews aspects of early-onset sepsis in the newborn infant (clinical presentation in the first 48 hours) as almost all of these cases are maternally acquired. Microbiological, epidemiological, pathophysiological and clinical aspects of the disease are discussed, and the practical implications of adopting preventative programmes are addressed.

Intrauterine growth restriction (IUGR) has a variety of causes and this article will focus on those which may be related to pathology of the trophoblast – so-called placental insufficiency. The main message we wish to convey is that the aetiology of these cases of IUGR is not solely related to abnormalities of uterine or umbilical bloodflow but is also likely to involve specific placental transport mechanisms. Amino acid transporters, in particular, are implicated.

The intrapartum management of the twin pregnancy has remained a controversial and challenging issue in obstetrics. Development of a management plan for delivery of a twin gestation necessitates consideration of multiple factors including fetal presentations, gestational age, estimated fetal weights, the presence of maternal or fetal complications, and the experience of the attending obstetrician, anaesthetic staff and neonatologists. In twin gestations in which a trial of labour is possible, the major factor determining the intrapartum course is the relative presentations of twin A and twin B on admission to the delivery suite.

Sonography during the first trimester of pregnancy is essential in twin pregnancies. This is due to the fact that a short two minute scan can reliably determine chorionicity and amnionicity. However, if the scan is not performed until the second or third trimester, the determination of chorionicity and amnionicity may be tedious and time consuming at the end of which many competent sonographers will frequently mis-assign chorionicity and amnionicity. A first trimester scan can therefore determine the appropriate management of the patient for the entire duration of the pregnancy.

Approximately 1 in 4 of all babies are born with cord round the neck. Being such a common obstetric condition, there is a view that nuchal cord ordinarily does no harm. A number of studies have recognised cord round the fetal neck as a significant cause of fetal death in utero and perinatal morbidity. However, many obstetricians have different views about the significance of nuchal cord as a cause of perinatal morbidity and mortality.