In pregnancy the uterus and its contents constitute a growing mass of tissue with an increasing need for oxygen and substrates. Muscle activity is associated with an even more dramatic increase in metabolic demands. One might question if the physiological adaptations are adequate to provide for the combined demands of exercise and pregnancy.

Antiphospholipid antibodies (aPLs) are a diverse group of autoantibodies with specificity for phospholipid surfaces. Antiphospholipid antibodies may be found in individuals with a clinical history of thrombotic events or in women suffering severe pregnancy complications typically involving fetal compromise or demise. The association is known as the antiphospholipid syndrome (APS).

Obstetric cholestasis (OC) also known a intrahepatic cholestatsis of pregnancy (ICP) is defined as pruritus of onset in pregnancy in association with abnormal liver function in the absence of any other identifiable liver pathology which resolves on delivery. It may be associated with adverse obstetric outcome and significant maternal morbidity. In the UK the prevalence is thought to be 0.6–0.7%, with up to 39–41% of women with OC being of Indian or Pakistani origin. Higher prevalence is also observed in Scandinavia (2%) and Chile (4%), (especially women of Araucanian Indian descent 24%). The condition occurs more commonly amongst twin pregnancies (20–22%) and is more common in the winter months in both Scandinavian and Chilean populations. The condition may occur more frequently in those >35 years of age (25% of cases).

Approximately 1 in 4 of all babies are born with cord round the neck. Being such a common obstetric condition, there is a view that nuchal cord ordinarily does no harm. A number of studies have recognised cord round the fetal neck as a significant cause of fetal death in utero and perinatal morbidity. However, many obstetricians have different views about the significance of nuchal cord as a cause of perinatal morbidity and mortality.

Improvements in anaesthetic care and postoperative management over the last two decades have significantly improved survival of neonates with ventral abdominal wall defects, from a dismal 47% in 1971, to 96% for both gastroschisis and isolated omphalocele in two recent series. This increased survival has generally been attributed to result from improvements in the pre and postoperative management of these fragile neonates. Specifically, the routine use of total parenteral nutrition, and staged repairs for cases with severe “viscero-abdominal disproportion” have been implicated in a decreased incidence of sepsis, morbidity and mortality. In addition, an appreciation of the wide spectrum of anomalies uniquely associated with gastroschisis and omphalocele have helped improve survival, as each has unique pathophysiologic features that have prognostic implications for the fetus before, during and after delivery.

The prophylactic use of low-dose aspirin for prevention of preeclampsia has been an important research question in obstetrics for the last three decades. In 1979, Crandon and Isherwood observed that nulliparous women who had taken aspirin regularly during pregnancy were less likely to have preeclampsia than women who did not. In 1985, Beaufils et al published the first randomized trial suggesting that 150 mg aspirin and 300 mg dipyridamole daily from 3 months’ gestation onwards decreased the risk of preeclampsia, fetal growth restriction and stillbirth in high-risk women. Subsequently, more than 50 trials have been carried out throughout the world and a meta-analysis of these studies reported that the administration of low-dose aspirin in high-risk pregnancies is associated with a decrease in the rate of preeclampsia by approximately 10%. Consequently, several national professional bodies recommend that high-risk pregnancies should be treated with aspirin (50–150 mg daily).