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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