In the 1960s caesarean section accounted for approximately 3% of births in many nations of the Western world. By the mid-1980's, however, this rate was beginning to increase and concern was not only being expressed at the rising numbers of babies being delivered abdominally but also at the four-fold difference in national rates, from 5% of births in Czechoslovakia to 18% of births in the United States. This difference, it was argued, could not be explained either by variability in the characteristics of women living in these various countries, nor in their fetuses. The increased use of caesarean section at this time was attributed to a lowering of the threshold at which the operation was being used to manage dystocia (delayed progress in labour), breech presentation, fetal distress and the delivery of small or pre-term infants. The large difference between caesarean rates in North America and some European countries was felt to be due to differences in the management of dystocia and of women who had previous caesarean deliveries.

Twenty-five years have passed since the first “test tube baby” was born in 1978. Since then, more than 1 million children have been born world-wide. Today, they represent 2% of all new-borns in some countries, such as Sweden. After conventional in vitro fertilisation (IVF) was established, the cryopreservation technique developed and the first baby produced implementing this technique was born in 1984. The cryopreservation technique is firmly established in most IVF programmes at present. The introduction of intracytoplasmic sperm injection (ICSI) in 1992 has given many men the opportunity to father children, hitherto an impossibility.

The adverse effects of alcohol on the developing human have been known since historical times but were not introduced into the medical literature before the late 1960's when French doctors reported that alcohol abuse during pregnancy might cause serious damage to the unborn child. Independently, the same observations were made in the United States, and in 1973 the term fetal alcohol syndrome (FAS) was introduced. Since then, FAS has been recognized in most industrialized and developmental countries where alcohol is widely used. Because of the magnitude of the problem, “The Committee to Study Fetal Alcohol Syndrome” in 1996 published a comprehensive report on the present state of diagnosis, epidemiology, prevention, and treatment of the disorder. The report recognised that only recently, during the last 20 years, have we become aware of the profound impact of substance abuse on individuals, their families, and society. Of all current substance abuse, alcohol is undoubtedly the most serious problem, both when considering the frequency of the disorder, and alcohol's power to injure the embryo and fetus.

The maintenance of the structural integrity of the fetal membranes is critical for successful progression of pregnancy. At term rupture of the fetal membranes (ROM) does not occur until the onset of labour-associated contractions in 90–95% of deliveries. This is often referred to as ‘spontaneous’ ROM, but since ‘spontaneous’ is also employed clinically to distinguish ‘natural’ from ‘artificial’ rupture, ‘labour-associated’ ROM (LROM) may be a more appropriate terminology. In the remaining 5–10% of term deliveries the membranes rupture prior to the onset of clinically apparent contractions. This has been referred to as ‘premature’ ROM, but it is less ambiguously defined as ‘pre-labour’ ROM (PROM). In direct contrast to the situation at term, PROM precedes 30–40% of preterm deliveries. If iatrogenic deliveries are excluded, PROM precedes 50% of preterm births, and represents the major cause of preterm birth. There is therefore great interest in the mechanisms underlying membrane rupture whether PROM or LROM.