Anaemia that has not corrected by 24 weeks is the signal to act on

The edition in brief

Today's obstetrics and gynaecology desk opens with a secondary analysis of a three-arm Indian randomised trial in 4,252 singleton pregnancies with moderate iron deficiency anaemia. Each 1 g/dL rise in haemoglobin by 20 to 24 weeks was associated with a lower risk of stillbirth (relative risk 0.74, 95% CI 0.56 to 0.98), and risk rose progressively once haemoglobin stayed below 10.5 g/dL. The practical message is that the repeat haemoglobin, not the prescription, is the point of decision. An expert clinical review consolidates multiple sclerosis care across the reproductive years, updating 2014 recommendations: disease activity can usually be held by continuing or timing disease-modifying therapy rather than stopping it, and the postpartum months carry the concentrated medical and psychological risk. A cohort of 961 pregnancies with preterm prelabour rupture of membranes shows the condition splits into four intra-amniotic categories; only intra-amniotic infection, present in 17%, carried clearly raised odds of early-onset neonatal sepsis (adjusted odds ratio 3.4, 95% CI 1.7 to 7.0). In 600 term fetuses with an estimated weight below the 10th centile, adding slow growth velocity to Doppler and biometric criteria did not improve prediction of adverse outcome (area under the curve 0.64 versus 0.64). A clinic pearl covers telling vulvar dermatoses from genitourinary syndrome of menopause. The edition closes with a quality-improvement study in which a 60-unit oxytocin protocol in the third stage was associated with less postpartum haemorrhage after vaginal birth (8.5% to 5.2%, adjusted relative risk 0.60, 95% CI 0.42 to 0.86), with no signal after caesarean.