Planned VBAC is associated with an approximately 1 in 200 (0.5%)
risk of uterine rupture

GBS is present in the bowel flora of 20–40% of adults (this is called ‘colonisation’). People who are colonised are called
‘carriers’. This includes pregnant women (there is no evidence that its carriage rate is specifically affected by pregnancy).

In the event of an intrauterine death (IUD), where no sample can be obtained from the baby, an appropriate dose of prophylactic anti-D Ig should be administered within
72 h of the diagnosis of IUD, irrespective of the time of subsequent delivery.

• No screening test is entirely accurate.
• 17% to 25% of women who have a positive swab at 35–37 weeks of gestation will be GBS negative at delivery.
•  5% to 7% of women who are GBS negative at 35–37 weeks of gestation will be GBS positive at delivery.
• Many of the babies who are severely affected from GBS infection are born prematurely, before the suggested time for screening.

For potentially sensitising events after 20weeks gestation,
a minimum anti-D Ig dose of 500 IU should be administered within 72 h of the event.

Caesarean section is the recommended mode of delivery in cases of cord prolapse when vaginal birth is not imminent in order to prevent hypoxic acidosis.
Category 2 caesarean birth can be considered for women in whom the fetal heart rate pattern is normal, but continuous assessment of the fetal heart trace is essential.

In case of cord prolapse in advanced labor , delivery should be expedited.

A document on categories of Caesarean section can be found here-CLICK HERE

In pregnancies<12 weeks gestation, anti-D Ig prophylaxis is only indicated following ectopic pregnancy, molar pregnancy, therapeutic termination of pregnancy and in
cases of uterine bleeding where this is repeated, heavy
or associated with abdominal pain. The minimum dose should be 250 IU. A test for fetomaternal haemorrhage (FMH) is not required

• The timing of delivery should be tailored to the patient.
• If history of vaginal bleeding/ other risk factors for preterm delivery- consider ‘Late preterm delivery’- 34+0 to 36 +6 weeks.
• If uncomplicated placenta previa- Consider between 36+ 0 and 37+0.

Antenatal treatment for vaginal or rectal colonisation does not reduce the likelihood of GBS colonisation at the time of delivery and so is not indicated in this situation.

IAP should be offered to GBS-colonised women

A dose of 250 IU anti-D immunoglobulin should be sufficient to cover up to five adult therapeutic doses of D positive platelets given within a 6-week period.

In severely thrombocytopenic patients with platelet count of?30 × 10^9/L, anti-D Ig should be given subcutaneously, or IV.

Routine ultrasound screening is not useful. Selective ultrasound screening can be considered for women with breech presentation at term who are considering vaginal birth.

Read about Intrapartum Care in VBAC-

https://obgresource.com/2021/12/10/intrapartum-care-in-vbac-2/

Successful VBAC is more likely among women with previous caesarean for
fetal malpresentation (84%) compared with women with previous caesarean for either labour dystocia (64%) or fetal distress (73%) indications.