Hip extension at crowning did not protect the perineum in a 1,206-woman trial

The edition in brief

In a pragmatic randomised trial of 1,206 nulliparous women delivering vaginally at term, directing hip extension at crowning did not reduce second- to fourth-degree tears on intention to treat (66.6% vs 66.2%). As-treated differences in anal sphincter injury did not survive adjustment, and a quarter of the intervention group did not adhere. A UK Obstetric Surveillance System cohort of 210 pregnancies in women with pre-existing cardiomyopathy recorded no maternal deaths, median delivery at 38.1 weeks, heart failure in 10% and arrhythmia in 8%, with one in five babies admitted to the neonatal unit. A post hoc ADORE analysis suggests the FADS Indel genotype may predict who gains from 1,000 mg/day DHA: early preterm birth was 1.1% with high dose versus 4.3% with low dose in I-allele carriers, but numbers were small. A single-centre Chinese trial of 150 women found an ilioinguinal-transversus abdominis plane block with liposomal bupivacaine cut 24-hour sufentanil use by 37% against a standard TAP block. US vital statistics show age-standardised hypertensive disorders of pregnancy rose 74% between 2016 and 2024. The pearl: postpartum blood pressure often peaks days after birth, so follow-up after pre-eclampsia cannot stop at discharge.