Objective To evaluate the effectiveness of 200 mg of daily vaginal natural progesterone to prevent preterm birth in women with preterm labour.Design Multicentre, randomised, double-blind, placebo-controlled trial.Setting Twenty-nine centres in Switzerland and Argentina.Population A total of 385 women with preterm labour (24 0/7 to 33 6/7 weeks of gestation) treated with acute tocolysis.Methods Participants were randomly allocated to either 200 mg daily of self-administered vaginal progesterone or placebo within 48 hours of starting acute tocolysis.Main outcome measures Primary outcome was delivery before 37 weeks of gestation. Secondary outcomes were delivery before 32 and 34 weeks, adverse effects, duration of tocolysis, re-admissions for preterm labour, length of hospital stay, and neonatal morbidity and mortality. The study was ended prematurely based on results of the intermediate analysis.

Introduction: To compare tocolysis with magnesium sulfate versus atosiban regarding the occurrence of short-term preterm labor and maternal side effects during and after open fetal myelomeningocele (MMC) repair. Material and Methods: A prospective nonrandomized cohort study was performed including 30 fetal MMC cases. The first 15 cases (group 1) received magnesium sulfate according to the MOMS protocol. In the following 15 cases (group 2), magnesium sulfate was substituted by atosiban. Chorioamniotic membrane separation (CMS), premature prelabor rupture of the fetal membranes (PPROM), preterm delivery <3 weeks after fetal MMC repair, and maternal complications due to the tocolytic medication were the major endpoints. Results: In both groups, one CMS but no PPROM was diagnosed <3 weeks after fetal MMC repair. One patient of group 2 delivered <3 weeks after fetal MMC repair because of an intraoperative placental abruption at 25 weeks. All women of group 1 showed an electrolyte imbalance during magnesium sulfate administration. One woman of group 1 developed several episodes of a third-degree atrioventricular block within the first 3 days after fetal surgery. Lethargy was found in all women during magnesium sulfate therapy. No maternal side effects were found under atosiban. Discussion: The use of atosiban resulted in an almost identical short-term uterine outcome without any serious maternal complications as seen when magnesium sulfate was given. Thus, the authors suggest using atosiban instead of magnesium sulfate in the context of open fetal surgery.

Aims: Breastfeeding significantly benefits mothers and infants. We aimed to identify the determinants of its successful initiation. Methods: A retrospective study of 1893 mothers delivering healthy term singletons at a Swiss university hospital from 1/2008 to 3/2009 determined the associations between multiple breastfeeding and early postpartum parameters by univariate and multiple regression analysis. Results: Multiparity was associated with nursing exclusively at the breast at discharge (P < 0.001), less use of maltodextrin supplement (P < 0.05), bottle/cup (both P < 0.001), but more pacifier use (P < 0.05). Among obese mothers, nursing exclusively at the breast at discharge was less frequent, and use of all feeding aids more frequent, than among normal-weight women (both P < 0.001). Neuraxial anesthesia was associated with use of maltodextrin and bottle (both P < 0.05) compared to no anesthesia. Delayed first skin-to-skin contact and rooming-in for < 24 h/day were each associated with maltodextrin and cup (P < 0.05). Nursing exclusively at the breast at discharge was less frequent (P < 0.001), and bottle use more frequent (P < 0.05), in women with sore nipples than in those without. Conclusions: Obesity is a potent inhibitor of breastfeeding initiation. Delivery without anesthesia by a multi parous normal-weight mother, followed by immediate skin-toskin contact, rooming-in for 24 h/day, and dedicated nipple care, provides the best conditions for successful early postpartum breastfeeding without the need for feeding aids or nutritional supplements.

Objective To systematically categorise all maternal and fetal intervention‐related complications after open fetal myelomeningocele (fMMC) repair of the first 124 cases operated at the Zurich Centre for Fetal Diagnosis and Therapy. Design A prospective cohort study. Setting Single centre. Population Mothers and fetuses after fMMC repair. Methods Between 2010 and 2019, we collected and entered all maternal complications following fMMC repair into the Clavien–Dindo classification. For fetal complications, a classification system based on the Medical Dictionary for Regulatory Activities terminology of Adverse Events was used including the preterm definitions of the World Health Organization. Main outcome measures Systematic classification of maternal and fetal complications following fMMC repair. Results Gestational ages at surgery and birth were 25.0 ± 0.8 and 35.4 ± 2.0 weeks, respectively. In 17% of all cases, no maternal complications occurred. Maternal intervention‐related complications were observed as follows: 69% grade 1, 36% grade 2, 25% grade 3, 6% grade 4 and 0% grade 5. In 34%, no fetal complications were noted; however, 43% of the fetuses developed a grade 1, 14% a grade 2, 8% a grade 3, 2% a grade 4 and 2% a grade 5 complication. Conclusion This study raises awareness of complications following open fMMC repair; 6% of mothers and 2% of fetuses experienced a severe complication (grade 4) and perinatal death rate of 2% was observed (grade 5). These data are useful for prenatal counselling, they help to improve the system of fetal surgical care, and they allow benchmarking with other centres as well as comparison with fetoscopic approaches. Tweetable abstract Systematic classification of all maternal and fetal intervention‐related complications following open fMMC repair.