The edition · Obstetrics & Gynaecology
Extended-cycle pills match cyclic ones on pregnancy prevention; recovered LV function after peripartum cardiomyopathy does not stop relapse
A WHO-linked review puts continuous and extended combined pills level with 21/7 regimens, a pooled cohort analysis shows peripartum cardiomyopathy relapses whether or not the ventricle recovered, and three trials report on aspirin timing, a perinatal therapy app and intrapartum azithromycin.
The edition in brief
A systematic review of 18 randomised trials and 10 other studies found continuous or extended-cycle combined oral contraceptives prevented pregnancy as well as 21/7 or 24/4 regimens (unintended pregnancy OR 0.79, 95% CI 0.41 to 1.52), with fewer total bleeding days in some trials but more unscheduled bleeding. The VTE estimate was imprecise (OR 1.05, 0.16 to 6.79; about 0.7 extra cases per 1000 users). A meta-analysis of six cohorts (266 women) with prior peripartum cardiomyopathy found relapse in a later pregnancy was not significantly less common when LVEF had recovered to 50% or more (rate ratio 0.77, 0.50 to 1.19), though maternal death was lower (1.7% vs 10.9%). A post hoc analysis of the ASPIRIN trial (11,908 women in low-resource settings) found aspirin's effect on preterm delivery did not vary with start week between 6 and 13 weeks, or with adherence. In a Japanese trial of 350 pregnant women, a self-guided interpersonal-therapy app did not change depressive symptoms in pregnancy but showed a small benefit at one month postpartum (SMD 0.28). In the A-PLUS follow-up, 2 g intrapartum azithromycin did not change 2-year Bayley cognitive scores in asphyxiated newborns (mean difference 0.29, -1.77 to 2.34). The practical message: continuous pill-taking is a legitimate default choice, and every woman with prior peripartum cardiomyopathy needs preconception cardio-obstetric counselling whatever her echo shows.
Continuous or extended-cycle combined pills prevent pregnancy as well as 21/7 regimens
Continuous or extended combined pill-taking prevents pregnancy as well as a monthly break; offer it routinely and prepare women for early unscheduled bleeding.
Aspirin's effect on preterm birth did not depend on starting week or adherence in the ASPIRIN trial
In nulliparous women where aspirin is used against preterm birth, starting anywhere from 6 to 13 weeks appears equally effective — start at booking.
A self-guided interpersonal-therapy app did not change depressive symptoms in pregnancy but helped modestly after birth
A self-guided interpersonal-therapy app was acceptable and gave a small postpartum benefit; use it alongside screening, not instead of referral.
Intrapartum azithromycin did not improve 2-year development after birth asphyxia
Intrapartum azithromycin gave no neurodevelopmental benefit at two years in asphyxiated newborns.
Managing breakthrough bleeding on continuous combined pills
Exclude causes, then use a short hormone-free break of up to four days to settle bleeding on continuous pills.
After peripartum cardiomyopathy, a recovered ejection fraction does not protect against relapse in a later pregnancy
Relapse after peripartum cardiomyopathy is common even when the ejection fraction has recovered; counsel and monitor every woman, not only those with reduced function.
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