In the Obstetrical Journal of Great Britain and Ireland (August 1878), Dr Hamilton from Falkirk, Scotland wrote an article entitled “mortality in childbed statistics”. Quoting a Dr Murphy, he stated that “in 75,911 cases of midwifery occurring in British practice, there were 138 forceps cases, and in thirty five of these, or one in every four, the child was stillborn”. Then, as now, obstetricians were discussing intervention during labour and were divided in their views, with one side claiming that intervention caused fetal loss, while the other side being convinced that only by intervention would lives of mothers and babies be saved.

The diagnosis of twin pregnancy whilst causing delight for many of the parents and families involved is a source of concern and worry for their obstetric caregivers. This review will not deal with the myriad complications of twin pregnancies but will concentrate on two for which Doppler ultrasound has been often discussed; placental insufficiency and the problems of shared placental circulations in monochorionic twins.

Delivery of an infant via an abdominal and uterine incision has a very long history. It is impossible to discover when the first such operation was performed, but it is known to have been practised in ancient Roman, Hindu and Egyptian civilisations. Usually it was performed on a recently dead mother in the hope of saving the infant, but there is also some evidence that in ancient times it may occasionally have been attempted on living mothers. In more recent centuries, there are several reports of caesarean sections being performed on living patients in Europe from 1500 onwards. The date of the first successful operation is uncertain, but there is no doubt that mortality of both mothers and infants was very high. In the British Isles, out of 131 caesarean sections performed between 1737 and 1878, only 23 mothers survived. The high maternal mortality was not surprising considering that there was no anaesthesia nor effective control of infection, and the uterine incision was not closed.

Fetal asphyxia as a cause of brain damage has been a concern since the 19th century when the association of asphyxia during labour and asphyxia before the onset of labour to deficits in children was proposed. The significance of fetal asphyxia as a cause of brain damage remained obscure until the middle of the 20th century when the systematic examination of the effect of asphyxia and ischaemia on the fetus began in the research laboratory.

The results of these laboratory studies have provided the foundation of our current understanding of the role of fetal asphyxia as a cause of brain damage. Clinical studies have provided an opportunity to determine if these concepts are equally relevent to the human fetus.