Midline episiotomy at vacuum birth linked to more sphincter injury

The edition in brief

In 5,277 operative vaginal deliveries from the US MFMU APEX cohort, any episiotomy was associated with higher odds of obstetric anal sphincter injury (adjusted OR 1.45, 95% CI 1.25-1.67), but the cut mattered: midline episiotomy at vacuum delivery was associated with more injury whatever the parity, while mediolateral episiotomy was associated with less injury in women without a previous vaginal birth. This is observational and the mediolateral group was small. A patient-level pooled analysis of 55 pregnancies with Crimean-Congo haemorrhagic fever found maternal mortality of 28.8% and fetal loss of 57.4%; third-trimester ribavirin was associated with lower maternal mortality (OR 0.33, 95% CI 0.13-0.84). The disease is endemic in parts of western India, so a febrile, bleeding pregnant woman with livestock or tick exposure needs it on the list. A meta-analysis of eight trials (1,811 women) found cognitive behavioural therapy lowered EPDS scores (SMD -0.59) and nearly doubled clinical improvement (RR 1.84), with evidence certainty very low to moderate. A 94-woman Chinese trial found tegileridine PCA after elective caesarean cut nausea and vomiting from 23.9% to 6.5% with similar pain control; the drug is not available in India and the trial is small.