Mechanical ripening holds up in trial of labour after caesarean

The edition in brief

A systematic review of 20 studies and 28,035 observations examined transcervical balloon cervical ripening during trial of labour after caesarean. Against prostaglandin induction the odds of complete uterine rupture were lower (Mantel-Haenszel OR 0.43, 95% CI 0.26-0.72; risk difference -19 per 1,000). No difference was detected against spontaneous labour (OR 1.29, 95% CI 0.90-1.84) or oxytocin alone. Dehiscence, however, was reported more often after balloon-based induction (OR 1.86, 95% CI 1.06-3.29). Certainty was very low throughout, and because amniotomy or oxytocin almost always followed catheter placement, the estimates describe a strategy rather than the catheter itself. A Cochrane review of 87 trials and about 36,000 participants found low-dose mifepristone reduced pregnancy compared with levonorgestrel for emergency contraception (RR 0.73, 95% CI 0.59-0.90, high certainty), with mid-dose showing RR 0.67 (0.49-0.91). Delayed menses was the main adverse effect. Seventy-nine of the 87 trials were conducted in China. Ten years of uterus transplantation across four American centres produced 60 transplants, 42 recipients with a live birth or ongoing pregnancy, and 48 neonates at a median 36 5/7 weeks. Reoperation was needed in 28.3% of recipients and 14.3% of living donors. A meta-analysis of reproductive risk factors in postmenopausal women found later menopause associated with fewer cardiovascular events (pooled estimate 0.94 per 5-year increase, 95% CI 0.90-0.98), with no clear association for parity, age at first birth or pregnancy loss; certainty was low to very low. An umbrella review of nine syntheses found immediate postpartum or postabortion LARC insertion lowered 6-month pregnancy rates but raised intrauterine device expulsion, most sharply after vaginal delivery (RR 5.09, 95% CI 2.04-12.73).