Mepivacaine eased IUD placement pain; stopping antidepressants in pregnancy linked to more crisis visits

The edition in brief

Today's obstetrics and gynaecology edition leads on perinatal mental health and ends on a procedural trial. A Pennsylvania claims cohort of 1,462 people who entered pregnancy on an SSRI or SNRI found that most had a treatment gap of more than 60 days, and that discontinuation was associated with more mental health emergency visits in pregnancy and in the eight months after birth. It is observational, but it argues for a planned conversation rather than a reflex stop. A meta-analysis of eight studies (554 women) with bipolar disorder found a pooled postpartum recurrence of 21% with lithium prophylaxis against 41% without, with the authors cautioning about confounding by indication. A French population cohort of 3,905 second twins found that caesarean for the second twin after vaginal birth of the first was associated with about three times the risk of severe neonatal morbidity or death; missing neuraxial analgesia, transverse lie and low-volume units were associated with needing it. The practice changer is a 370-participant Swedish double-blind trial: 10 mL of intrauterine mepivacaine 2 minutes before IUD placement in nulliparous women lowered mean pain from 58.6 to 43.8 mm and raised tolerability, with a number needed to treat of 15. The pearl covers how to plan antidepressant decisions before and during pregnancy.