Complete and comprehensive surveillance of maternal mortality and maternal near miss should increase the consistency and accuracy of the data. Extremes of age, pre-existing medical conditions, language barriers, ethnicity, and socioeconomic status are recognized risk factors for maternal and obstetric complications. An important challenge to the identification of maternal near miss outcomes has historically been varying definitions between local, national, and international institutions. The majority of definitions may be classified as clinically based, organ system based, or management/intervention based. Organ-system dysfunction criteria are based on abnormalities detected by laboratory tests, such as platelet levels, and basic critical care monitoring. Complications from pre-existing medical conditions such as chronic heart disease are emerging as an important cause of maternal near miss, as improvements in medical care allow more women to live to reproductive age. Effective prevention policies are necessary to influence the long-term outcomes associated with maternal near miss.

Instrumental vaginal deliveries can be hazardous in inexperienced hands and should be undertaken with due care and supervision. In cases of fetal distress it is essential that the instrumental delivery be straight forward as the combination of trauma and hypoxia is potentially damaging to the fetus. In general, ventouse delivery is preferred when the position is occipitotransverse or occipito-posterior to allow for autorotation of the fetal head during traction unless the accoucher is experienced in Kielland's rotational forceps delivery. Where maternal expulsive efforts may be compromised, forceps may be better than ventouse delivery. Maternal complications are higher with forceps whilst neonatal complications are more common with the use of ventouse. Although instrumental delivery is a service provided in both basic and comprehensive essential obstetric care, it is under-used in low-resource settings. After delivery, an adequate review of overall conduct of the delivery, perineal repair and postpartum care should follow.

The aim for genetic services is to provide a maximum of genetic diagnostic capabilities for any given pregnancy, with a minimum of fetal risk. This chapter focuses on the procedures and techniques currently available to clinicians to evaluate genetic disorders. Amniocentesis was first introduced in the 1880s as a treatment for hydramnios. Genetic amniocentesis usually is performed after 15 completed weeks of gestation. After ultrasonic study to confirm dates, fetal viability, fetal number, fetal anatomic survey and placentation, the patient is requested to empty her bladder. Prior to the attempt at transcervical biopsy (TC-CVS), an ultrasonic scan is performed to evaluate fetal viability, fetal number, placentation, and dating by crown-rump length (CRL) and gestational sac size. Complications associated with CVS include vaginal bleeding, amniotic fluid leakage, infection, fetalmaternal transfusion, teratogenic effects, and fetal loss. The future for prenatal genetics is clearly one of high technology and continue.