Moderate anaemia that has not responded by mid-pregnancy was linked to more stillbirths

The edition in brief

Three findings lead today. In a secondary analysis of a large Indian randomised trial of intravenous versus oral iron for moderate iron deficiency anaemia (4,252 women treated at 14–17 weeks), each 1 g/dL better haemoglobin response at 20–24 weeks was associated with lower stillbirth risk (RR 0.74, 95% CI 0.56–0.98), and risk of stillbirth and birth before 34 weeks climbed as haemoglobin fell below about 10.5 g/dL. It is an association, not proof that pushing haemoglobin higher prevents stillbirth, but it supports rechecking haemoglobin after treatment rather than assuming the first course worked. A single-centre before-and-after study found that switching to 60 units of oxytocin over one hour in the third stage was associated with fewer postpartum haemorrhages of 1,000 mL or more (11.2% vs 14.3%, adjusted RR 0.77), with the benefit confined to vaginal births; caesarean births showed no clear difference. A Czech cohort of 961 pregnancies with preterm prelabour rupture of membranes who had amniocentesis found intra-amniotic infection in 17%, and early-onset neonatal sepsis in 12% of those babies against 2% when the fluid was clear of both inflammation and microbes. A small nuMoM2b follow-up of women with preterm hypertensive disease found longer expectant management was not linked to worse overall cardiovascular health at 2–7 years, though CRP and non-HDL scores were slightly worse. The pearl covers the postpartum cardiovascular follow-up owed to anyone who had pre-eclampsia.