Gestational diabetes mellitus (GDM) is defined as ‘carbohydrate intolerance of variable severity with onset or first recognition during pregnancy’. GDM affects approximately 4–10% of all pregnancies in the United States. Pregnancies complicated by GDM have both short and long term effects on the developing fetus. Studies have shown that elevated levels of glycaemia are associated with increased perinatal mortality. O'Sullivan et al. in his original work, found a four-fold higher rate of perinatal mortality in untreated women with gestational diabetes when compared to women with a normal glucose tolerance test in the same time period. Pettit et al., when studying Pima Indians, found a direct association between a 2-hour, 75g glucose load result and perinatal mortality. Evaluation of recent studies concerning gestational diabetes revealed relatively high rates of stillbirth and perinatal mortality. Thus, it is clear that lack of a therapeutic regimen for these patients will result in increased fetal mortality.

The incidence of premature delivery (at less than 37 completed weeks) has been stable at between 5–10% of deliveries over the past 20 years despite intensive research in this field. Preterm delivery is a major cause of perinatal morbidity and mortality. The identification of women at increased risk for this condition has traditionally been based on clinical history (e.g. previous premature birth or second-trimester miscarriage), digital evaluation of the cervix and the occurrence of uterine contractions.

Emergency anaesthesia for the compromised fetus encompasses anaesthesia for both acute fetal distress and the chronically hypoxic fetus. Fetal distress, a poorly defined term, is still used by clinicians today. Parer and Livingston defined fetal distress as “progressive fetal asphyxia, that if not corrected or circumvented, will result in decompensation of the physiologic responses (primarily redistribution of blood flow to preserve oxygenation of vital organs) and cause permanent central nervous system and other organ damage or death.” More recently the term “non-reassuring fetal status” has been adopted as a better descriptor than fetal distress.

Group B streptococcus (GBS), or Streptococcus agalactiae, has been a continuing focus of debate in the paediatric and obstetric worlds. The organism has emerged as the leading cause of early-onset neonatal sepsis. With an average of 20% of mothers being carriers for the organism (range from 15–40%), the following questions remain to be answered:

1 How best to screen for GBS and which protocol to use?

2 How best to counsel patients who are GBS carriers?

3 What is the cost effectiveness of the screening protocols?

It is only in the last decade that increasing recognition has been given to the impact of childbirth on the physical and psychological wellbeing of a woman. The fall in maternal mortality coupled with a rise in female life expectancy (80 years in the UK) have served to focus attention on quality of life. Childbirth has been implicated as a major aetiological factor in pelvic floor and perineal trauma.