The search continues for improved methods of detection of fetal distress. This review discusses the use of cord blood erythropoietin, umbilical artery blood velocity waveform, continuous fetal heart rate monitoring, and fetal biophysical profile scoring in the detection of fetal distress. Also discussed are a number of situations where pregnancy is complicated by either obstetric conditions such as breech presentation, vaginal birth after previous caesarean section, or accompanying systemic disease, including previous organ transplantation, cardiac disease, and substance abuse among parturients.