The management of children with cleft lip and palate presents many challenges but also many rewards. Our involvement with these children and their families often begins before birth and can extend into late adulthood. Affected individuals present a multiplicity of problems and effective management involves a wide range of specialists.

The combined spinal epidural (CSE) as an anaesthetic technique for providing analgesia for labour and anaesthesia for operative delivery has gained in popularity over the last ten years. Essentially the CSE consists of identification of the epidural space and insertion of an epidural catheter plus the initial intentional placement of an intrathecal dose of opioid, local anaesthetic or both, all as a single procedure. Theoretically the technique combines the advantages of the speed of onset and the reliability of block achieved by subarachnoid anaesthesia with the flexibility provided by the presence of an epidural catheter and avoids their individual disadvantages. The complications that may be encountered are those attributable to subarachnoid and epidural anaesthesia individually but some are unique to the CSE technique. The CSE technique is also applicable to other situations in obstetrics where a block is initiated by subarachnoid anaesthesia and its continuation is facilitated by the presence of an epidural catheter, either to maintain anaesthesia for prolonged procedures or for post operative pain control. The CSE's popularity has been ensured by the fact that it has allowed rapid onset analgesia with minimal motor blockade to be provided routinely for mothers in labour.

Venous thromboembolism (VTE) is a leading cause of maternal mortality in the western developed world. VTE may present as deep vein thrombosis (DVT) or pulmonary embolism (PE) but if untreated can result in fatal PE. Although fatal PE is clearly the most significant consequence of VTE in pregnancy, DVT also often leads to morbidity related to the development of post-thrombotic syndrome (PTS). Pregnancy is an independent risk factor for VTE and the risk of VTE is 4–10 fold higher in pregnant women than in non-pregnant women of similar age. The puerperium represents a time of even higher risk. It is clear that many additional high-risk situations in pregnancy lower the threshold for thrombosis and warrant measures to prevent VTE and its complications. Risk factors for pregnancy-related VTE may be inherited or acquired. Acquired risk factors may be specifically related to the pregnancy or may have developed prior to pregnancy. Well-documented risk factors for pregnancy-related VTE include delivery by Caesarean section, previous VTE, and inherited or acquired thrombophilia. Other risk factors that have been identified include obesity, multiparity, multiple gestation, pre-eclampsia and medical conditions, such as sickle cell disease, that predispose to VTE. Our ability to diagnose VTE overall is poor as presenting signs and symptoms are extremely varied and unreliable. This is further complicated in pregnancy where signs and symptoms suggestive of VTE are common and invasive testing is more complicated. It is essential that physicians be vigilant in monitoring patients for the development of VTE and maintain a low threshold for considering thromboprophylaxis. Guidelines have recently been published by several medical societies to help with these difficult decisions. In this review the risk factors for the development of VTE in pregnancy will be discussed and guidelines for risk assessment presented. Management of patients who develop VTE in pregnancy is also outlined.

Apart from the measurement of blood pressure, dipstick analysis of urine for protein is the most commonly performed antenatal screening test. The presence of proteinuria is seen as a possible indication of many complications in pregnancy, from urinary tract infection to chronic renal disease and it remains central to the diagnosis of pre-eclampsia in a hypertensive pregnancy. It has both diagnostic and prognostic implications when it is found though the optimal methods for detection and quantification in primary and secondary care remain controversial.