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Pre-eclampsia is a pregnancy-specific disorder that can significantly alter maternal physiology and result in a considerable threat to maternal and fetal health. Although many of the mechanisms involved in its pathophysiology have been elucidated, significant knowledge gaps remain. Perhaps as a result, there is no known treatment for the condition, and birth is the only known cure. The optimal timing of birth can present a difficult decision in the face of maternal or fetal demise; therefore maternal and fetal condition must be monitored and stabilised with the aim of prolonging pregnancy until this time is evident, or until birth becomes necessary. Intervention involves screening pregnant women with the aim of initiating aspirin prophylaxis for those deemed to be at increased risk. This article discusses the pathophysiological mechanisms involved in pre-eclampsia, factors that may impact on pathophysiology, controversies around screening, and the mechanism of aspirin prophylaxis.

Advances in technology over the past 30 years enable us to assess fetal health using safe and non-invasive ultrasound techniques. One such technique is fetal heart rate monitoring, and in pregnancies where there is fetal compromise the fetal heart rate contains crucial information with regard to the optimum timing of delivery. The features of the fetal heart rate are well understood, but numerous studies have shown that expert assessment of traces is prone to inconsistency. In addition, when junior or inexperienced staff review traces important features may not be noticed, with the danger that critical decisions are delayed. Computer analysis of the fetal heart rate using Sonicaid FetalCare or the care analysis built into Sonicaid fetal monitors is therefore a welcome and much-needed way of standardizing interpretation to the highest standards. Such analysis captures an enormous amount of clinical experience and in effect brings it to the bedside.

The influence of the midwife is vital in enhancing the physiological processes of labour. This article focuses on fetal physiology and gives insights into how the fetus experiences labour. Awareness is raised of possible adverse factors, which if introduced into the care could detract from maternal and fetal health. The role of the midwife in protecting fetal wellbeing is emphasized.