Advances in both imaging techniques and in treatments for immune thrombocytopenias affecting the fetus have allowed for more accurate antenatal predictions of severe disease and effective antenatal treatments for those fetuses who are at risk of sequelae. This article will review current knowledge of the diagnosis and treatment of affected fetuses in alloimmune thrombocytopenia and in immune thrombocytopenic purpura.

The adhesion of cells to each other, to other cell types and to the extracellular matrix (ECM) is a crucial part of development and relies on the expression of cell adhesion molecules (CAMs) and their ligands. For example, at implantation, the trophoectoderm attaches to the uterine epithelial surface and CAMs play a major role in this process. Following attachment, interstitial and intravascular invasion of maternal tissue by trophoblast is required to develop the maternal-placental-fetal circulation and this too requires a new repertoire of CAM expression. Understanding the part played by adhesion molecules in pregnancy is paramount because several pregnancy associated disorders including pre-eclampsia, fetal growth retardation, miscarriage and infertility problems have been linked to abnormalities in expression of particular CAMs and/or their ligands. The aim of this article is to review the major CAM families and their role in human pregnancy. Excellent reviews which include reference to animal studies can be found elsewhere.

Pharmacological analgesia given to a mother during labour may affect the fetus and newborn in a number of ways. Firstly a drug may cross the placenta and exert a direct effect on the baby. Secondly a method of analgesia may alter maternal physiology or biochemistry and in so doing it may have an indirect effect on the baby. Thirdly it may affect the interaction between mother and baby after delivery. This latter aspect is rather the province of the psychologists. The effects on the baby of different methods of anaesthesia for operative delivery are well researched but are more exclusively the responsibility of anaesthetists and therefore of less import to obstetricians than is analgesia. These will be discussed only insofar as research findings may also be applicable to analgesic methods.