Down’s syndrome (DS) is the commonest single cause of severe mental retardation and accounts for just under a third of all cases. Until the late 1980’s population screening was based on offering amniocentensis to older women. This made little impact on the prevalence of DS because the majority (approximately 70%) of babies with DS are born to women under the age of 35 (Figure 1).

For an infant without lethal congenital malformations there is no risk greater than to be born too early. In addition, preterm birth with its many consequences may compromise the life of the whole family. Thus, prevention of preterm birth is one of the greatest challenges in obstetrics. However, this has proven to be difficult. This difficulty is in part due to the fact that, although we know a large number of clinical factors which are know a large number of clinical factors which are associated with preterm birth, the final mechanisms triggering the onset of preterm contractions or premature rupture of the fetal membranes (PROM) have remained largely unclear. We review the prevention of preterm birth in the light of the newest data; an interested reader is also referred to other recent overviews on the same topic.

Originally all low birthweight infants were considered to be premature. When prematurity was redefined in terms of gestational age (SGA) and not preterm. With the large scale collection of obstetric data the distributions of birthweight at different gestational ages were described and from these, infants who were SGA could be defined. SGA became synonymous with terms such as growth retardation, but it soon became appearent that the two were not necessarily interchangeable. Scott and Usher found that it was the degree of soft tissue wasting rather than birthweight that related to poor perinatal outcome. Miller and Hassanein stated that: “birthweight by itself is not a valid measure of fetal growth impairment”. They used Rorher’s Ponderal Index (weight (g) × 100/length (cm)) to diagnose the malnourished or excessively wasted infants with reduced soft tissue mass. Most studies of intrauterine growth retardation (IUGR) still use low birthweight for gestational age centile as their only definition of IUGR or only study infants who have a low birthweight. Altman and Hytten expressed disquiet about this definition and stated: “There is now an urgent need to establish true measures of fetal growth from which deviations indicating genuine growth retardation can be derived” and that “it is particularly important that some reliable measures of outcome should be established”. In large series of term deliveries published recently, two groups of IUGR infants with different growth patterens have been identified. These studies confirm that birthweight alone is inadequate to define the different types of IUGR. They established that low Ponderal Index (PI) is a measure of IUGR associated with an increased incidence of perinatal problems and that it is time to re-evaluate IUGR in terms of the different types of aberrant fetal growth.

It is remarkable that, for all the sophistication of current obstetric practice, uncertainty should persist concerning the management of as fundamental a problem as breech presentation, particularly with respect to the place of external cephalic version (ECV). This review will focus on information available for guiding clinical decisions, and practical aspects of the procedure.

Systemic lupus erythematosus (SLE) is a multi-system disorder belonging to the connective tissue group of diseases characterized by circulating non-organ-specific autoantibodies. Its incidence may be increasing and, as milder cases are recognized, it is becoming a condition likely to be encountered in many medical settings. The peak onset is during the child-bearing years when the sex ratio approaches 13:1 in favour of females. Fertility rates are normal and hence pregnancy becomes a common management problem in this group of patients.