Scanning for a big baby finds a third of them and changes what you do to all of them

The edition in brief

A retrospective cohort of 21,743 singleton pregnancies scanned routinely at 35-37 weeks found third-trimester ultrasound had 34.9% sensitivity for large-for-gestational-age and 35.6% for macrosomia, with specificity 97.4% and 95.6%. Screen-positive pregnancies were less likely to attempt labour (adjusted RR 0.87, 95% CI 0.84-0.90) and more likely to have intrapartum caesarean (aRR 1.47, 1.30-1.67), with higher composite adverse maternal (aRR 1.43, 1.32-1.55) and neonatal (aRR 2.37, 1.85-3.05) outcomes. False positives had more operative vaginal delivery (aRR 1.29, 1.07-1.57) and maternal morbidity (aRR 1.28, 1.11-1.48) than true negatives, with no neonatal difference. False negatives had less induction and caesarean than true positives, with no excess neonatal harm. A single-centre cohort of 961 pregnancies with preterm prelabour rupture of membranes between 23 and 37 weeks, all undergoing amniocentesis at admission, classified four intra-amniotic categories: intra-amniotic infection 17%, sterile intra-amniotic inflammation 7%, microbial invasion without inflammation 11%, and neither 65%. Early-onset neonatal sepsis occurred in 12%, 4%, 5% and 2% respectively. Intra-amniotic infection carried adjusted odds of 3.4 (95% CI 1.7-7.0) for early-onset sepsis. Ureaplasma accounted for nearly two-thirds of microbial detections; other bacteria carried worse outcomes. A review offers a morphology-driven framework for distinguishing genitourinary syndrome of menopause from inflammatory, infectious and neoplastic vulvar disease, and sets out when to biopsy and when to refer. A secondary analysis of 142 nuMoM2b participants with preterm-onset hypertensive disorders found longer expectant-management latency was not associated with overall cardiovascular health at 2-7 years, but was associated with worse non-HDL scores and higher high-sensitivity CRP.