Balloon ripening after caesarean: lower rupture odds than prostaglandins

The edition in brief

A systematic review in AJOG pooled 18 non-randomised studies and two trials of balloon-based induction during trial of labour after caesarean. Complete uterine rupture was less likely than with prostaglandin induction (OR 0.43, 95% CI 0.26 to 0.72; about 19 fewer per 1,000) and not detectably different from spontaneous labour or oxytocin alone, although dehiscence was reported more often (OR 1.86). Certainty was very low and balloon placement was nearly always followed by amniotomy or oxytocin. A Danish case-control series found vulvar lichen sclerosus associated with more second-degree tears (RR 1.37) and more anal sphincter injuries (RR 3.37), especially with a narrowed introitus or symptoms during pregnancy. US birth data showed hypertensive disorders of pregnancy rising 74% between 2016 and 2024. The practice changer is a nationwide Swedish cohort of 856,380 first-time mothers: family history of venous thromboembolism carried a graded risk of postpartum clots, from HR 1.50 with a distant relative to HR 3.66 with several close ones. The pearl: examine the anal sphincter after every perineal tear before suturing.