The edition · Obstetrics & Gynaecology
What we do before pregnancy, and what we do in the third stage
A half-million-birth linkage study puts a number on the obstetric cost of pre-pregnancy uterine surgery; a 156-study meta-analysis argues against screening for genital mycoplasmas; and a quality-improvement series makes the case for 60 units of oxytocin.
The edition in brief
Today's obstetric reading runs from preconception counselling to the third stage of labour. A New South Wales record-linkage study of 520,050 first births found uterine surgery before the first birth in 14.7% of women, associated with later preterm birth (adjusted OR 1.51, 95% CI 1.47-1.55) and stillbirth (adjusted OR 1.39, 1.26-1.53), with associations strengthening after repeated procedures. It is observational and confounding by indication is unresolved, but it sharpens the question asked before a dilatation, a polypectomy or a diagnostic hysteroscopy in a woman who has not yet had a child. A systematic review of 156 studies found cervicovaginal Ureaplasma parvum associated with preterm birth (OR 1.63, 1.36-1.96) and Mycoplasma hominis with preterm birth (adjusted OR 1.75, 1.21-2.53) and low birthweight (OR 1.81, 1.51-2.16) - and its authors explicitly conclude the data do not support routine screening or treatment. The A-PLUS neurodevelopmental follow-up, across six sites including two in India, found a single 2 g intrapartum dose of azithromycin made no difference to Bayley-III cognitive scores at two years in children with birth asphyxia (mean difference 0.29, 95% CI -1.77 to 2.34). An Australian accelerometer cohort of 84 women found no relationship between objectively measured supine sleep in late pregnancy and customised birthweight centile, which complicates the standard advice without overturning it. The edition closes on a single-centre quality-improvement series in which moving from 30 units to 60 units of oxytocin over the first hour of the third stage was associated with less postpartum haemorrhage (14.3% to 11.2%, adjusted RR 0.77, 0.64-0.93), driven entirely by vaginal births.
Uterine surgery before a first birth tracks with later preterm birth and stillbirth
Take a specific history of previous uterine surgery at booking and count the procedures; where surgery is still being considered before a first pregnancy, check a medical alternative has been ruled out.
Genital mycoplasmas in the cervix and vagina: an association, and an argument against screening
This is a reason to understand a positive cervicovaginal mycoplasma result, not a reason to look for one - do not start screening, and do not treat asymptomatic detection.
Intrapartum azithromycin did not improve neurodevelopment after birth asphyxia
Azithromycin in labour has no neurodevelopmental benefit after birth asphyxia - keep the indication narrow.
Measured supine sleep showed no relationship with fetal growth
Sleep-position advice stands on the stillbirth literature, not on fetal growth - and a woman who finds herself supine on waking needs reassurance, not a scan.
Weigh the swabs: estimated blood loss is the weakest number on the partogram
Weigh, do not estimate - and say the running total out loud, because a haemorrhage recognised at 700 mL is a different clinical problem from one recognised at 1,500 mL.
Doubling third-stage oxytocin was associated with less postpartum haemorrhage after vaginal birth
Review the first-hour oxytocin dose in your third-stage protocol; the evidence for raising it applies to vaginal birth, and any change should go in alongside quantitative blood loss measurement and a pump reprogramme.
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