Short cervix, no prior preterm birth: vaginal progesterone holds its place

The edition in brief

Today's obstetrics edition leads on induction after caesarean. A systematic review of 20 studies (very low certainty) found that a balloon-based induction strategy in trial of labour after caesarean was associated with lower odds of complete uterine rupture than prostaglandin induction (OR 0.43) and no detectable difference from spontaneous labour or oxytocin alone, though dehiscence was reported more often. A Swedish nationwide cohort of 856,380 first-time mothers found a dose-graded association between family history of venous thromboembolism and postpartum VTE, from HR 1.41 for an affected grandparent to 3.66 for the highest hereditary score. A phase 2 polysomnography trial of elinzanetant in postmenopausal women with hot flushes and disrupted sleep showed less wakefulness at week 4 (about 22 minutes) but no difference at week 12 on the primary measure. The pearl covers the practical mechanics of transvaginal cervical length screening. The edition closes on a Bayesian network meta-analysis of 26 trials in women with a sonographic short cervix and no previous spontaneous preterm birth: vaginal progesterone alone reduced preterm birth before 34 weeks (RR 0.56, high certainty) and carried fewer maternal adverse events than combination regimens, which the authors suggest keeping within research settings.