Cord milking for flat late-preterm and term babies, GLP-1 exposure reassurance, and aspirin's residual risk

The edition in brief

Four items for obstetricians. A Canadian technical update suggests that intact umbilical cord milking may be considered for infants of 35 weeks or more who stay non-vigorous after 15 seconds of deferred clamping and stimulation; it may reduce moderate to severe hypoxic-ischaemic encephalopathy and the need for cardiorespiratory support without a clear rise in jaundice needing phototherapy. A meta-analysis of 22 studies and 49,395 exposed pregnancies found no consistent link between periconceptional GLP-1 receptor agonist exposure and major adverse outcomes; a small renal malformation signal (OR 1.23, 95% CI 1.09-1.39) probably reflects confounding. A secondary analysis of a stepped-wedge trial in 2919 high-risk women on low-dose aspirin found that chronic hypertension, raised mean arterial pressure and higher first-trimester estimated risk marked those who still developed preterm pre-eclampsia (3.7%). A single-centre retrospective cohort of 396 expectantly managed early-onset pre-eclampsia found that more antihypertensive escalations were associated with more maternal complications, suggesting the treatment trajectory may be a marker of disease progression.