Rh-negative in the resus bay, cerclage in the clinic

The edition in brief

Today's obstetrics and gynaecology edition opens with a transfusion argument that has quietly changed. Low-titer group O whole blood is usually RhD-positive, and giving it to an RhD-negative trauma patient with reproductive potential risks anti-D alloimmunisation and haemolytic disease in a pregnancy that may be years away. That risk was accepted because whole blood was assumed to save lives; two randomised trials of prehospital traumatic haemorrhage found no survival advantage over component therapy, so the trade-off no longer holds. The recommendation is to default to RhD-negative products for these patients until the type is confirmed, and to guarantee free follow-up when an incompatible transfusion happens. The SOGC has published a national standard for screening and counselling about alcohol in pregnancy and in women of reproductive age, GRADE-rated, with an emphasis on validated screening tools, brief intervention and expedited referral to cessation expertise. A secondary analysis of the Danish REPAIR trial followed 442 women with second-degree tears or episiotomy: 12.7% had a clinically relevant wound complication. Prolonged active second stage (aOR 2.25, 1.11-4.46) and deep tear (aOR 2.11, 1.10-4.24) predicted it; prophylactic amoxicillin-clavulanic acid was protective (aOR 0.34, 0.18-0.65). Episiotomy alone was not independently associated. A review of menopausal hormone therapy after risk-reducing salpingo-oophorectomy argues that fear of breast cancer is keeping treatment from BRCA carriers who were pushed into surgical menopause a decade early. ACOG's new cerclage guideline closes the edition: indications, technique and alternatives, each recommendation carrying its own strength and evidence grade.