This chapter discusses pre-term labour, abnormalities at different stages of labour, placenta accreta, and certains emergencies such as cord prolapse and shoulder dystocia. The management of threatened preterm labour is aimed at maximising neonatal survival by prolonging the pregnancy. The administration of corticosteroids 24 to 48 hours prior to delivery significantly improves perinatal morbidity and mortality. Oxytocin is commonly used in abnormal labour and effectively increases uterine activity and causes cervical dilatation. Uterine hyperstimulation is a common side effect of oxytocin administration and this is the reason for the incremental regime used to accelerate or induce labour. Retained placenta is a cause of major obstetric haemorrhage. Abnormal progress in the first and second stages of labour is associated with fetal malpresentations and malpositions. Shoulder dystocia is a very serious obstetric emergency and in current obstetric practice is a significant cause of perinatal morbidity and mortality.

Drugs used in obstetrics merit special mention because they have their effects on two patients rather than one. This chapter provides an understanding of the drugs commonly used by obstetricians, including drugs to increase uterine contractions, ergometrine, prostaglandins, tocolytics, atosiban, nifedipine, and beta2-adrenergic agonists. Oxytocin is a nonapeptide used to induce and augment labour and also to minimise post-delivery blood loss. The main use of tocolytics is to stop premature labour. They have also been used to facilitate delivery during Caesarean section by uterine relaxation and to treat uterine hyperstimulation, preventing fetal distress. Antihypertensive agents are widely used during pregnancy but they all cross the placenta and the available evidence does not always suggest that they are of benefit. Increasing the number of antenatal exposure of steroids is associated with reduced cognitive function, an increase in behavioural disorders and reduced birth weight.