CIN2 on surveillance is often not CIN2, and uterine surgery leaves a mark on the first birth

The edition in brief

In a Danish cohort of 437 women aged 23 to 40 under active surveillance for CIN2, three expert pathologists regraded about 40% of biopsies: 12.8% up to CIN3 and 27.5% down to CIN1 or normal. Later CIN3 or worse occurred in 22.5%, 42.2% and 64.3% of the expert-CIN1/normal, CIN2 and CIN3 groups, and stayed high with high-grade cytology or HPV16 whatever the histology. An Australian record-linkage study of 520,050 first births found uterine surgery before the first pregnancy was associated with preterm birth (aOR 1.51) and stillbirth (aOR 1.39), stronger with repeated procedures; confounding by indication is unresolved. A meta-analysis of 28 observational studies associated heat exposure with hypertensive disorders of pregnancy (OR 1.58) and pre-eclampsia (OR 2.01), with very high heterogeneity. A US cohort of 6.9 million births showed the link between BMI and stillbirth depends on pre-pregnancy diabetes. An Obstetrics & Gynecology commentary argues that, after two prehospital trials found no survival advantage for whole blood, RhD-positive whole blood is hard to justify for RhD-negative patients who may conceive when compatible products exist.