The incidence of surrogacy is rising. Literature on associated obstetric risks is scarce and caution must be exercised when labelling surrogate pregnancies as low risk. Although obstetricians’ responsibilities lie with the surrogate mother, they must ensure her wishes do not conflict with the best interests of the baby. Prepregnancy counselling is the key to a successful surrogacy arrangement. Learning objectives: To gain an awareness of the different types of surrogacy. To understand the law surrounding surrogacy. To learn about antenatal, intrapartum and postpartum care in surrogacy. Ethical issues: When the surrogate mother's wishes and the interests of the child conflict, do obstetricians have the right to discuss this with the commissioning parents without her consent? When should obstetricians seek ethical and legal support? Please cite this article as: Bhatia K, Martindale EA, Rustamov O, Nysenbaum AM. Surrogate pregnancy: an essential guide for clinicians. The Obstetrician & Gynaecologist 2009;11:49–54.

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Elevated maternal levels of alphafetoprotein (AFP) in midtrimester are believed by some to be a useful screening test for premature labour, low birthweight and low birthweight for gestation. In a prospective study on 887 randomly selected pregnant women we found that although there was an association between low birthweight and elevated AFP, the test would miss five out of every six cases of low birthweight and there would be nine false-positives for every case correctly identified. The test is not therefore sufficiently predictive of low birthweight to be of value as a screening test for this condition.

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We have reviewed the management of pregnant women presenting with acute myeloblastic leukaemia (AML) at the London Hospital since 1972. Six women in the second or third trimester were diagnosed with AML over this period. One woman had termination of pregnancy at presentation in the second trimester. Three of the remaining five patients achieved complete remission following chemotherapy during pregnancy. Delivery was achieved by the vaginal route in three and by caesarean section in one patient. All were livebirths but one infant had Down's syndrome. Median maternal survival was 16 months (range 0-44 months). Long-term survival was achieved for both mother and infant in only one case. Longer maternal survival was seen in patients treated in the period 1980-1985. Increased survival appears to be related to the introduction of more aggressive chemotherapy schedules and improved supportive care.

We investigated non-attendance at colposcopy clinic. This was a retrospective case-control study conducted to find out any specific characteristics for women who failed to attend their appointment at colposcopy during a 3-month period, in comparison to attenders. The incidence of non-attendance was 23.7%. Younger age, smoking, occurrence of pregnancy, previous history of termination of pregnancy, anxiety and follow-up appointments were more common in non-attenders.

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Case report REFERENCESEckshtein N., Ismajowich B., Yedwab G. et al. (197%) Combined tubal and multiple intrauterine pregnancies following ovulation induction. Fertility and Sterility 30, 707-109. Fleisher A. A. and Seaman I. (1961) Heterotopic pregnancy: the effect of shock on the first-trimester fetus. Obstetrics and Gynecology 18, 763-166. Pardanani N. and Smalkin M. D. (1979) Combined intrauterine and extrauterine pregnancy diagnosed by ultrasound.A 35 year old woman was admitted to hospital in the eighth week of her third pregnancy with persistent nausea and vomiting. Routine examination and blood The Royal College of Radiologists Clinical Oncology Symposium-Ovarian Cancer