The six-week blood pressure check after pre-eclampsia is the one most often missing

The edition in brief

An English primary-care cohort of 39,934 women with hypertensive disorders of pregnancy found that more than half had no blood pressure recorded at six weeks postpartum. Among those who did, an abnormal reading was associated with a higher 20-year risk of cardiovascular disease (10.9% vs 5.4%; adjusted HR 1.96, 95% CI 1.51 to 2.54), and two-thirds of events occurred before age 40. The finding is observational, but the gap it exposes is practical: the postnatal check is often not done. A meta-analysis of ten randomised trials (2,745 women) found that adjuncts to external cephalic version raised success (RR 1.53), most clearly tocolysis (RR 2.39) and neuraxial anaesthesia (RR 1.75), though heterogeneity was high and caesarean rates did not fall significantly (RR 0.88, 0.76 to 1.02). A EudraVigilance disproportionality analysis found a meningioma reporting signal for desogestrel-only pills (110 reports; ROR 11.11) and a weaker exploratory one for drospirenone-only pills; spontaneous-report data cannot measure risk, and the authors caution against using it to choose between methods. ACOG has issued a graded clinical practice guideline on vasomotor, sleep and mood symptoms of menopause. The pearl covers what to do at the postnatal review after a hypertensive pregnancy.