Induction of labour describes the artificial stimulation of the onset of labour and occurs in up to 20% of pregnancies in the United Kingdom. Both mechanical and pharmacological methods of induction of labour exist. In the vast majority of women, the recommended method of induction of labour is by the use of vaginal prostaglandin E2. Induction of labour is associated with less maternal satisfaction and potentially increased rates of instrumental delivery and caesarean section compared with spontaneous vaginal delivery. Therefore, the decision for induction of labour should not be undertaken lightly and appropriate counselling of the mother with appropriate documentation of the provision of information in addition to the indications, risks, benefits and alternatives to induction of labour is advocated.

Preterm pre-eclampsia (prior to 37 weeks’ gestation) remains a major cause of maternal and fetal morbidity and mortality particularly in low to middle income countries. Much research has focused on first and second trimester predictors of pre-eclampsia with the aim of allowing stratification of antenatal care and trialling of potential preventative and therapeutic agents. However, none have been shown to be of benefit in randomised controlled trials. In this literature review we critically evaluate predictive and diagnostic tests for preterm pre-eclampsia and discuss their clinical use and potential value in the management of preterm pre-eclampsia. We defined preterm pre-eclampsia as pre-eclampsia occurring prior to 37 weeks’ gestation. Substantial progress has been made in the development of predictive screening tests for preterm pre-eclampsia, but further research is needed prior to their introduction and integration into routine clinical practice. The performance of diagnostic tests mainly utilising angiogenic and anti-angiogenic factors for determining time to delivery in later pregnancy currently hold more promise than first trimester predictive tests, possible reflecting the heterogeneity of pre-eclampsia.

•Preeclampsia remains a condition associated with morbidity and mortality.•Preeclampsia is thought to occur as a result of a two stage process.•Conflicting evidence regarding aetiology reflects the heterogeneity of the condition.•The development of tests to date has focused on first or second trimester screening.•PlGF and sFLT-1 are widely used as tests to assist in determining need to delivery.•PlGF in combination with clinical parameters is also useful in the first trimester prediction.•However, larger robust clinical trials are required.•A phase IIa clinical study is currently being performed using a metabolomic platform.•Robust clinical studies similar to this are required to examine other biomarkers.•There is a need to address the translational gap between biomarkers and clinical practice.

Connective tissue disorders, particularly those that are autoimmune, are being seen with increasing frequency in the pregnant population. The care of these patients in pregnancy ranges from the routine to the complicated, with some of the conditions posing significant risks both to the mother and the fetus. Dermatological conditions are often encountered in pregnancy, and again range from the benign to those resulting in serious fetal and maternal morbidity, with a number being specific to pregnancy. An important issue for both groups of disorders is the use of particular medications during pregnancy. Those with pre-existing disease should ideally be counselled pre-pregnancy to optimize treatment and adjust medication as appropriate. During pregnancy, frequency of review and degree of treatment will depend on the severity of the condition, and may require multidisciplinary team involvement to optimize both maternal and fetal outcome, including obstetric physicians, obstetricians, anaesthetists, neonatologists, and geneticists.

Hypertensive disorders of pregnancy remain a common complication of pregnancy and a major cause of maternal and perinatal morbidity and mortality worldwide. Hypertensive disorders range from mild gestational hypertension to early onset pre-eclampsia which remains a leading cause of maternal death worldwide. Although there have been major advances in understanding the pathophysiology of the disease in recent years, interventions to screen for and prevent hypertensive disorders of pregnancy have had disappointing results. Due to their unpredictable nature and potential poor outcomes, patients with hypertensive disorders of pregnancy warrant cautious care including consultant obstetric, neonatal and anaesthetic involvement to optimise both maternal and fetal outcomes.