The edition · Obstetrics & Gynaecology
The six-week blood pressure that most notes never record
After a hypertensive pregnancy, an abnormal or missing six-week reading was linked to twice the later cardiovascular risk. Also: the RSV vaccine and gestational hypertension, induction at BMI 40 or more, steroids in twins, and salpingectomy beyond the gynaecology theatre.
The edition in brief
An English cohort of about 40,000 women with hypertensive disorders of pregnancy found that more than half had no blood pressure recorded at six weeks postpartum, and that an abnormal reading at that point was associated with nearly double the risk of cardiovascular disease over up to 20 years (10.9% vs 5.4%, adjusted HR 1.96). Two-thirds of events occurred before age 40. A meta-analysis of nine studies found maternal RSVpreF vaccination associated with a small rise in hypertensive disorders (RR 1.08), carried by gestational hypertension and by observational data; randomised trials were not significant and pre-eclampsia was not increased. A secondary analysis of an induction trial found women with BMI of 40 or more took about 3.5 hours longer with vaginal misoprostol and had lower odds of vaginal birth. A meta-analysis of antenatal corticosteroids in twins found no clear reduction in neonatal death or respiratory distress, but more neonatal hypoglycaemia and NICU admission, on moderate-to-low certainty evidence. The edition closes on the ACOG clinical practice update supporting complete bilateral salpingectomy at obstetric and gynaecological surgery, and widening access during non-gynaecological abdominopelvic surgery, for prevention of epithelial ovarian cancer.
After hypertensive pregnancy, the six-week reading predicts the next 20 years
Record blood pressure at six weeks after any hypertensive pregnancy, and hand an abnormal reading on for follow-up.
RSV vaccine in pregnancy: a small gestational hypertension signal, not pre-eclampsia
Continue to offer maternal RSV vaccination and include the small, uncertain gestational hypertension signal in counselling.
Vaginal misoprostol induction runs longer at BMI 40 or more
When inducing at BMI 40 or more, set expectations for a longer induction and a lower chance of vaginal birth.
Antenatal steroids in twins: no clear benefit, more hypoglycaemia
Keep following steroid guidance in twins, but plan neonatal glucose checks after exposure and be cautious with late-preterm courses.
Write pre-eclampsia into the problem list, not just the delivery note
Put any hypertensive pregnancy on the woman's long-term problem list with a request for regular blood pressure checks.
Salpingectomy for ovarian cancer prevention moves beyond gynaecology theatres
Discuss complete bilateral salpingectomy for ovarian cancer risk reduction whenever a woman who has finished childbearing has pelvic surgery.
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