The edition · Obstetrics & Gynaecology
Universal aspirin cut severe pre-eclampsia by about a quarter in one high-risk service
A before-and-after cohort of 36,914 deliveries tests aspirin for everyone booking by 16 weeks; supervised exercise lowers gestational diabetes; hip extension at crowning does not spare the perineum; and ACOG widens opportunistic salpingectomy.
The edition in brief
Parkland Health dispensed 162 mg aspirin to every patient starting antenatal care by 16 weeks. Compared with the preceding epoch, preeclampsia with severe features fell from 6.9% to 5.1% (aOR 0.65, 0.60 to 0.72), with no rise in abruption or postpartum haemorrhage. It is an observational before-and-after comparison, so secular change cannot be excluded, but it supports the case for dropping risk-factor screening in populations with a high background rate. A meta-analysis of 19 randomised trials (6,213 women) found supervised exercise reduced gestational diabetes (RR 0.74, 0.57 to 0.96), gestational hypertension (RR 0.55) and macrosomia (RR 0.61), with larger effects when started early and sustained at 150 minutes a week or more. A pragmatic randomised trial of 1,206 nulliparous women found directing hip extension at crowning did not reduce second-degree or worse tears on intention-to-treat (66.6% vs 66.2%). ACOG has updated its guidance to support complete bilateral salpingectomy at obstetric and gynaecological surgery, and to extend the offer to non-gynaecological abdominopelvic operations, for primary prevention of epithelial ovarian cancer.
Aspirin for everyone booking by 16 weeks was associated with less severe pre-eclampsia
In a high-risk population, offering 162 mg aspirin to everyone booking by 16 weeks is a reasonable alternative to risk-factor screening, provided it is dispensed and adherence is followed.
Supervised exercise in pregnancy lowered gestational diabetes and hypertension
Refer women at booking to supervised exercise of about 150 minutes a week, combining aerobic and resistance training, to lower the risk of gestational diabetes.
Extending the hips at crowning did not reduce perineal tears
Do not change birth position at crowning to protect the perineum; hip extension did not reduce significant tears.
Aspirin before bed, from 12 weeks, until 36
Start aspirin by 16 weeks, advise night-time dosing and ask about missed doses at each visit.
ACOG backs complete salpingectomy at gynaecological surgery — and beyond it
When the abdomen is open for another reason and the family is complete, offer complete bilateral salpingectomy to reduce future ovarian cancer risk.
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