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Azithromycin in labour

Two contrasting outcomes for a similar therapy. Tita et al (N Engl J Med 2016;375:1231–41) randomised 2,013 women to receive azithromycin 500 mg intravenously as prophylaxis for caesarean section during labour or after membrane rupture in a multicentre trial in the USA; there was definite benefit for women in terms of lower rates of endometritis and wound infection, but no evident benefit for their babies. On the other hand, Oluwalana et al (Pediatrics 2016;139, February:e20162281) randomised 829 Gambian women to 2 g oral azithromycin or placebo during labour, with a 98% vaginal delivery rate. There was a substantial and highly significant difference in rates of maternal infections in the azithromycin group, and a smaller but still significant difference in the babies. Context is everything.

Breaking bad news in prenatal medicine

Practitioners of both fetal and neonatal medicine commonly find themselves in the same room with a family where a pre-natal problem has been identified. This may mean explaining about the implications of serious or potentially lethal fetal abnormalities, the implications of poor fetal growth, or the likelihood of extremely preterm delivery. …

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