The edition · Obstetrics & Gynaecology
Steroids for twins, lichen sclerosus at delivery, and the rarity of severe HDFN
A meta-analysis questions routine antenatal corticosteroids in twins, a Danish cohort links vulvar lichen sclerosus to sphincter injury, and US screening data put severe alloimmune disease in proportion.
The edition in brief
Today's obstetrics and gynaecology edition. A meta-analysis of 16 studies and 18,367 twin neonates found no clear reduction in neonatal death or respiratory distress with antenatal corticosteroids, but more neonatal hypoglycaemia (RR 1.80) and more unit admission; the evidence is mostly observational and guidelines have not changed. A Danish matched cohort found women with vulvar lichen sclerosus had a higher risk of second-degree tears (RR 1.37) and obstetric anal sphincter injury (RR 3.37), with introital narrowing and symptoms in pregnancy marking the highest-risk group. Modelling from 8.8 million US antibody screens estimated severe haemolytic disease of the fetus and newborn at 2.4 per 100,000 pregnancies, and anti-K reached critical titres more often than anti-D. In the SWAN cohort, women whose AMH started lower and fell slowly through perimenopause had worse postmenopausal cardiovascular risk profiles. The pearl covers checking the vulva at booking so lichen sclerosus is known before the second stage.
Vulvar lichen sclerosus raised the risk of anal sphincter injury at birth
Ask about and record vulvar lichen sclerosus before labour, and treat these women as at higher risk of sphincter injury.
Severe haemolytic disease of the newborn was rare, and anti-K drove most critical titres
Name every antibody on a positive screen and refer anti-K pregnancies to fetal medicine early, even with modest titres.
How AMH falls before the final period tracked later cardiovascular risk
Use the menopause transition to review cardiovascular risk, whatever the symptom burden; AMH is not a tool for it.
Look at the vulva before the second stage, not during it
A one-line question about vulvar itch at booking can change how the second stage is managed.
Antenatal steroids in twins: no clear neonatal benefit, more hypoglycaemia
Keep following guidance for steroids in twins, but time courses carefully and monitor exposed neonates for hypoglycaemia.
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