Hip extension at crowning did not spare the perineum

The edition in brief

A pragmatic randomised trial in 1,206 nulliparous women found that directing them to lower their legs and extend the hips at crowning did not reduce second-degree or worse perineal tears: 66.6% with extension versus 66.2% with usual positioning. A quarter of the extension group did not adhere, and the as-treated benefit seen for sphincter injury lost significance after adjustment. A UK Obstetric Surveillance System cohort of 210 pregnancies in women with known cardiomyopathy recorded no maternal deaths, heart failure in 10% and arrhythmia in 8%, and a median delivery at 38.1 weeks, which supports counselling that pregnancy is usually achievable with specialist care. A post hoc analysis of the ADORE trial suggested that carriers of the FADS insertion allele had more early preterm births on 200 mg/day DHA (4.3%) than on 1,000 mg/day (1.1%), while non-carriers gained little; this is hypothesis-generating, not a reason to genotype. A single-centre Chinese trial of 150 women found an ilioinguinal-TAP block with liposomal bupivacaine cut 24-hour sufentanil use by about 11 micrograms against a standard TAP block. The pearl covers the practical setting of sphincter-injury prevention.