Vaginal misoprostol outperforms dinoprostone for induction, and severe pre-eclampsia recurs in one in seven

The edition in brief

Five findings for obstetricians and gynaecologists. A systematic review of 44 randomised trial reports (13,644 term inductions) found vaginal misoprostol more likely than vaginal dinoprostone to achieve vaginal birth within 24 hours (OR 1.48, 95% CI 1.20-1.84), with less oxytocin, a shorter time to birth and no rise in caesarean birth; the 25 µg dose had less hyperstimulation. A retrospective US cohort of 560,295 people with two or more pregnancies found severe hypertensive disease recurred in 14.9% of those who had it in the index pregnancy (RR 16.0), rising to 22.9% when it began before 28 weeks. At Parkland Health, dispensing 162 mg aspirin to everyone booking by 16 weeks was associated with less pre-eclampsia with severe features (6.9% to 5.1%, aOR 0.65) without more abruption or haemorrhage, in a before-after comparison. A secondary analysis of C-STICH found no difference in pregnancy loss between high and low vaginal cerclage (aRR 0.88, 0.57-1.34), though high cerclage was associated with fewer births before 32 weeks. An umbrella review found immediate postpartum LARC reduced six-month pregnancy (RR 0.16) at the cost of more IUD expulsion after vaginal birth (RR 5.09).