Short cervix: vaginal progesterone alone stays the benchmark

The edition in brief

A bayesian network meta-analysis of 26 randomised trials in women with a sonographic short cervix and no prior spontaneous preterm birth found vaginal progesterone alone cut birth before 34 weeks (RR 0.56, 0.44–0.72, high certainty) and caused fewer maternal adverse events than combination regimens; pessary plus progesterone ranked highest but on low-certainty evidence. A meta-analysis of 20 studies of trial of labour after caesarean found balloon-based induction was not associated with more complete uterine rupture than oxytocin or spontaneous labour and had lower odds than prostaglandins (OR 0.43), though dehiscence was reported more often and certainty was very low. A Swedish cohort of 856,380 first-time mothers showed postpartum VTE risk rose with each affected relative, up to HR 3.66 for the highest family score. A secondary analysis of the APRIL trial suggests aspirin may prevent recurrent preterm birth only when the previous placenta showed maternal vascular malperfusion — a small, hypothesis-generating subgroup. A meta-analysis of telemedicine for gestational diabetes found possible benefits but very low certainty and prediction intervals crossing zero.