Hypertensive disorders in pregnancy are a leading cause of maternal and perinatal morbidity and mortality. Overall, hypertension complicates approximately 10% of pregnancies. The incidence is higher in patients with predisposing factors including nulliparity, multiple gestation, preexisting hypertension or diabetes, a previous pregnancy complicated by preeclampsia-eclampsia, familial history of preeclampsia, hydrops fetalis and rapidly growing hydatidiform moles.

Since the introduction of ultrasound into obstetrics during the 1960s, there has been rapid progress in the detection of genetic and nongenetic defects in utero. With the development of sampling procedures like amniocentesis, chorionic villus sampling (CVS) and fetal blood sampling, the obstetrician has been able to obtain fetal tissue and the parallel improvement in laboratory techniques has allowed the diagnosis of chromosomal anomalies and single gene defects from fetal cells. Amniocentesis and CVS have become well established techniques for routine prenatal diagnosis of chromosomal and metabolic disorders and fetal tissue is now accessible throughout all three trimesters.

Fetal reactivity to acoustic stimulation is a long-recognized phenomenon. Obstetrical interest in this phenomenon is usually considered to have begun with peiper’s report in 1925 of marked fetal movements following a pulsed, loud sound. Occasional attention to the subject was given in the subsequent five decades. Read and Miller are often credited with writing the first comprehensive clinical study of the usefulness of acoustic stimulation in evaluating fetal health. A clear finding in this study was the correlation between an abnormal contraction stress test and faliure of the fetus to respond to stimulation.

Caesarean section (CS) is one of the most common major operations performed around the world, yet operative rates vary considerably. This review will address the variation in caesarean section rates worldwide and changes in these rates over time. In addition we shall try to assess possible explanations for the differences and whether such differences are reflected in outcome.