The incidence of preterm birth in developed countries has steadily increased over the past two decades and now approaches 12.5% of all live births in the U.S. This is due, in part, to our incomplete understanding of the pathways that maintain uterine quiescence throughout pregnancy, as well as those that promote increased uterine contractility and cervical ripening leading to labour. It is clear that uterine quiescence throughout most of pregnancy is maintained by progesterone acting through its nuclear receptor (PR). Furthermore, there is increasing evidence that both preterm and term labour are associated with activation of inflammatory response pathways in the pregnant uterus and cervix. In this article, we will consider the factors that induce the inflammatory response leading to term and preterm labour. We also will review findings to support the novel concept that the maintenance of uterine quiescence vs. induction of uterine contractility is exquisitely controlled by the cross-repressive effect of progesterone/PR and inflammatory transcription factors, such as nuclear factor κB (NF-κB).

Evidence-based reviews and practice guidelines have identified a number of risk factors associated with vacuum assisted delivery (VAD) that may result in adverse effects on the newborn infant, injuries to the mother's genital tract, and difficulty or failure of the procedure. In addition, clinical circumstances that predispose to increased risk, such as the use of the vacuum extractor for rotational and mid-cavity procedures, have been highlighted as possible avoidable factors. Although there is general agreement that success of vacuum delivery depends on the knowledge, experience and skill of the operator, system analyses of adverse outcomes often reveal inadequate training as a major contributing factor. It is beyond the scope of this review to present the detailed knowledge and technical skills required for correct use of the vacuum extractor. A variety of teaching resources is available for this purpose and practitioners who wish to obtain more information are referred to them.

Adolescent pregnancy rates in the United Kingdom remain the highest in Western Europe. Interestingly, throughout most of Western Europe teenage birth rates fell during the 1970s, 80s and 90s, but in the United Kingdom rates have remained high. An increasing incidence has also been noted, with 49.9 births per 1,000 women under 18 in 2001 and 52.8 live births per 1,000 women in 2002.

Cardiac and respiratory systems undergo significant changes in pregnancy and the puerperium, and the course of disease of these two systems in pregnancy can be difficult to predict and manage. Good assessment and planning is essential for the general management of patients with cardiorespiratory disease and will directly impact on the anaesthetic services they require and receive.