Rapid and constant progress in prenatal diagnosis has made screening and diagnosis for fetal aneuploidy available in the first and early second trimester. However, relatively late diagnosis of severe fetal conditions has also increased due to better performance of routine second trimester ultrasound examination together with a systematic approach to fetal evaluation and determination of prognostic factors with increasing gestation. Such situations include fetal infections, brain abnormalities, and several osteochondrodysplasias. Prognostic uncertainty is often weighed against ethical and legal issues in the decision making process, leading to either early termination of a potentially normal fetus or a late termination of a fetus more severely affected with better definition of overall prognosis. Our aim is to review the current literature with regard to technique and potential complications of late terminations of pregnancy.

Reports in the 1970's by Snyder and others of opioid receptors in the brain and the substantia gelatinosa of the spinal cord triggered a search for endogenous opioid ligands (β-endorphin and the encephalin peptides) which might modify pain transmission. It was not long after that morphine was administered into the human epidural space for pain control, including obstetric patients.

In October 2000, Hannah et al published a randomised controlled trial comparing perinatal and maternal outcome between planned vaginal and planned caesarean deliveries of term breech pregnancies. The study was closed after an interim analysis, showing a reduced perinatal morbidity and mortality with planned caesarean section. The result was not unexpected, although a trial like this had been called for over many years to resolve the issue. Many cohort- and case-control studies, and two small randomised studies had been performed since 1959, when Wright reported a reduced perinatal mortality and morbidity with CS. A few large registry studies had shown a better perinatal outcome with caesarean delivery, whereas smaller studies often showed no statistically significant difference in outcome, often with the conclusion that vaginal delivery (VD) is safe.

Affecting 7–10% of pregnancies, pre-eclampsia is, in fact, the most common glomerular disease worldwide. It remains a leading cause of fetal growth restriction, premature birth, as well as infant and maternal morbidity and mortality. Epidemiological studies have identified numerous risk factors for the development of pre-eclampsia including a positive family history, race, nulliparity, advanced maternal age and the presence of pre-existing co morbidities such as kidney disease, hypertension or diabetes mellitus. The incidence of pre-eclampsia has increased by an alarming 40% over the past decade, likely due to the number of women delaying pregnancy and/or becoming pregnant despite the presence of other comorbid conditions.