Alcohol was discovered soon after the development of waterproof pots to store and transport water and fruit. Liquids produced by spontaneous fermentation of grains, sugars and fruits were found to enhance pleasure. During the middle ages alchemists discovered that distillation increased this power and thought they had found the elixir of life. Since then almost every culture has used alcohol. Each society has introduced its own restrictions on the availability, exports, imports and consumption of alcoholic beverages within its religious and political structure. Generally, drinking levels which interfere with self-control or result in individual, familial or societal harm are disapproved by all cultures.

Down’s syndrome (DS) is the commonest single cause of severe mental retardation and accounts for just under a third of all cases. Until the late 1980’s population screening was based on offering amniocentensis to older women. This made little impact on the prevalence of DS because the majority (approximately 70%) of babies with DS are born to women under the age of 35 (Figure 1).

The discipline of radiology owes its existence today to the discovery of bands of radiation in the electromagnetic spectrum which can penetrate human tissue, and thus can be exploited as windows for imaging. Magnetic resonance (MR) employs radio-frequency radiation and almost certainly represents the final such window in the electromagnetic spectrum for imaging. It is similar to Computerised Tomography (CT) in providing a cross-sectional display of body anatomy with excellent resolution of soft tissue detail. The images are essentially a map of the distribution density of hydrogen nuclei and parameters reflecting their motion in cellular water and lipids. The total avoidance of ionizing radiation, its lack of known hazard and the penetration of bone and air without attenuation, make it a particularly attractive non-invasive imaging technique.

All pregnancies are at some risk of adverse fetal and neonatal outcome. The risk increases, however, if the pregnancy ends too soon (preterm), or if it ends too late (postterm).

For an infant without lethal congenital malformations there is no risk greater than to be born too early. In addition, preterm birth with its many consequences may compromise the life of the whole family. Thus, prevention of preterm birth is one of the greatest challenges in obstetrics. However, this has proven to be difficult. This difficulty is in part due to the fact that, although we know a large number of clinical factors which are know a large number of clinical factors which are associated with preterm birth, the final mechanisms triggering the onset of preterm contractions or premature rupture of the fetal membranes (PROM) have remained largely unclear. We review the prevention of preterm birth in the light of the newest data; an interested reader is also referred to other recent overviews on the same topic.

The efficacy of labour is determined by uterine, fetopelvic and cervical factors. Whereas the first two of these are well recognized, acknowledgement of the modulating function of the cervix during labour is relatively new. In particular, clarification of the synthesis and metabolism of prostaglandins has contributed considerably to our understanding of the biological control of the cervix.

Diagnostic ultrasonography has achieved an almost universal role in the practice of obstetrics, due to technological improvements in equipment and the experience acquired by well-trained ultrasonographers. Within the general population, over 3% of children reportedly have major congenital malformations that are life-threatening, require major surgery or have serious cosmetic effects. Many of these malformations can be detected antenatally by obstetric ultrasound. The introduction of high frequency transvaginal ultrasonography is a major development in the area of obstetric ultrasonography. Using this method, fetal anomalies have been successfully identified as early as the first trimester of pregnancy, leading some investigators to advocate routine ultrasound examination during pregnancy in order to screen for fetal anomalies at a gestational age that permits consistently accurate diagnosis and maximizes parental choice.

Although antenatal care was widely introduced in the Western world only in the 20th century, it is now universally accepted and advocated as beneficial and advisable for all pregnant women and hence consumes a considerable amount of accommodation, equipment, professional time and costs to the women themselves. Resource use is rarely measured routinely but must vary enormously because of differences in the amount and intensity of care proposed, and in its uptake, in different geographical settings. However, even when resource use is at the lower end of the spectrum, antenatal care should be audited so that the needs of women and their babies can be best addressed.

During intrauterine life the fetus is bathed in amniotic fluid which provides a low resistance space for free movement and a buffer against external trauma. This fluid is produced in early pregnancy largely as a maternal dialysate, then as a fetal transudate. Fetal urine is the most important source of amniotic fluid after 16 weeks gestation. The control of amniotic fluid is complex and poorly understood; it arises from secondary partitioning of water within the fetoplacental extracellular space and reflects fetal fluid balance.

Originally all low birthweight infants were considered to be premature. When prematurity was redefined in terms of gestational age (SGA) and not preterm. With the large scale collection of obstetric data the distributions of birthweight at different gestational ages were described and from these, infants who were SGA could be defined. SGA became synonymous with terms such as growth retardation, but it soon became appearent that the two were not necessarily interchangeable. Scott and Usher found that it was the degree of soft tissue wasting rather than birthweight that related to poor perinatal outcome. Miller and Hassanein stated that: “birthweight by itself is not a valid measure of fetal growth impairment”. They used Rorher’s Ponderal Index (weight (g) × 100/length (cm)) to diagnose the malnourished or excessively wasted infants with reduced soft tissue mass. Most studies of intrauterine growth retardation (IUGR) still use low birthweight for gestational age centile as their only definition of IUGR or only study infants who have a low birthweight. Altman and Hytten expressed disquiet about this definition and stated: “There is now an urgent need to establish true measures of fetal growth from which deviations indicating genuine growth retardation can be derived” and that “it is particularly important that some reliable measures of outcome should be established”. In large series of term deliveries published recently, two groups of IUGR infants with different growth patterens have been identified. These studies confirm that birthweight alone is inadequate to define the different types of IUGR. They established that low Ponderal Index (PI) is a measure of IUGR associated with an increased incidence of perinatal problems and that it is time to re-evaluate IUGR in terms of the different types of aberrant fetal growth.

The normal thyroid secretes thyroxine (T4) and, to a lesser extent, triiodothyronine (T3). The T4 is transported in the circulation to peripheral tissues largely bound to thyroxine binding globulin (TBG); T3, which is produced in peripheral tissues by deiodination of T4, also binds to TBG. It is, however, the free thyroid hormone concentration which determines the metabolic state, by its action on T3 nuclear receptors in the cells of kidney, heart, liver, anterior pituitary and other tissues.

Major progress has been made in the knowledge and management of diabetes and pregnancy. However diabetes in pregnancy remains an important medical complication, with implications for mother and child in both the short and the long term. There are still controversies concerning the diagnostic criteria of gestational diabetes and concerning the best strategry for the treatment of this disorder. There is even less agreement about whether gestational diabetes is a pathological condition. The perinatal mortality in gestational diabetes has recently become as low as that in the general population. This has led to the conclusion that gestational diabetes is no more than a variant of metabolic adaptation during pregnancy. However, fetal hyperinsulinism is present in gestational diabetes, resulting in macrosomia, neonatal complications and most probably long term consequences. Improvements in the care of the preexisting insulin-dependent pregnant diabetic have been achieved but further progress in understanding the underlying mechanisms and in preventing and treating the disease are important goals for the near future.

Multiple pregnancy is associated with a high rate of perinatal loss – mainly due to preterm labour but with important contributions from fetal malformation, intrauterine growth retardation and twin-twin transfusion syndrome. The overall perinatal mortality rate is consistently around six times that of singleton pregnancies but the rate rises progressively with the number of fetuses. Rates of 63,164,200,214 and 416 per 1000 births have been recently reported for twins, triplets, quadruplets, quintuplets and sextuplets respectively. In addition to these alarming figures, it should be emphasized that the restricted concept of perinatal mortality obscures the real extent of loss. If we include late abortion (after 20 weeks), late neonatal deaths and deaths in infancy from perinatal causes, as well as the usual indices of perinatal mortality (stillbirths and early neonatal deaths) we find that the total loss rate from twin pregnancy alone doubles and may be close to 10%. Although the rate of loss from multiple pregnancies is now substantially higher than that associated with the pregnancies of diabetic women, the challenge of multiple pregnancy has not been met with the same commitment or organisation of specialized perinatal services as has diabetes.

It is remarkable that, for all the sophistication of current obstetric practice, uncertainty should persist concerning the management of as fundamental a problem as breech presentation, particularly with respect to the place of external cephalic version (ECV). This review will focus on information available for guiding clinical decisions, and practical aspects of the procedure.

This year marks the 250th anniversary of the discovery by William Hunter of the existence of two distinct circulations within the human placenta. Until relatively recently the placenta has been viewed with “respect” – a passive structure which occasionally elicited fear and anxiety if implanted either too low or too deep. More recently our understanding of perinatal physiology, blood flow regulation and epidemiological data linking prenatal events with adult disease has created renewed interest in the placenta. This review will focus on the regulation of fetal blood flow in the placenta, the possible mechanisms whereby it may be deranged and why this might be relevant to adult disease.

The most important congenital heart disorders occurring in children are mainly due to malformations of cardiac structure. The underlying anatomical defect is established soon after the heart is first formed in embryonic life, less than 8 weeks after conception. However, the full echocardiographic picture may not be apparent until after birth or even later in childhood.

Systemic lupus erythematosus (SLE) is a multi-system disorder belonging to the connective tissue group of diseases characterized by circulating non-organ-specific autoantibodies. Its incidence may be increasing and, as milder cases are recognized, it is becoming a condition likely to be encountered in many medical settings. The peak onset is during the child-bearing years when the sex ratio approaches 13:1 in favour of females. Fertility rates are normal and hence pregnancy becomes a common management problem in this group of patients.