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.

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.

This is GBS bacteruria. GBS bacteriuria is associated with a higher risk of chorioamnionitis and neonatal disease. Women with GBS bacteriuria should be offered IAP.

Women with GBS urinary tract infection (growth of greater than 10^5 cfu/ml) during pregnancy should receive appropriate treatment at the time of diagnosis as well as IAP. 

• 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.

The UK National Screening Committee examined the issue of strategies recommended that routine screening using bacteriological culture or near-patient testing techniques should not be introduced into UK practice.

The US Guidelines advise that all pregnant women should be offered screening for GBS carriage at 35–37 weeks of gestation and those found to be colonised with GBS should be offered intrapartum antibiotic prophylaxis.

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

After collection, swabs should be placed in a non-nutrient transport medium, such as Amies or Stuart. Specimens should be transported and processed as soon as possible. If processing is delayed, specimens should be refrigerated. When testing for GBS, the lab should be specifically informed that the swab is for GBS testing.

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 six elements considered to be reflective of good care are:
 Consultant obstetrician planning and directly supervising delivery.
 Consultant anaesthetist planning and directly supervising anaesthesia at delivery.
 Blood and blood products available.
 Multidisciplinary involvement in preoperative planning.
 Discussion and consent, including possible interventions (such as hysterectomy, leaving the placenta in situ, cell
salvage and interventional radiology).
 Local availability of a level 2 critical care bed.

According to the RCOG- Any lack of compliance with the care bundle by the clinical team for a woman with either placenta praevia or accreta
should be investigated.

According to MBBRACE-UK 2014 to 2016- Women who have had a previous caesarean section who also have either placenta praevia or an anterior placenta underlying the old caesarean section scar at 32 weeks of gestation are at increased risk of placenta accreta and should be managed as if they have placenta accreta, with appropriate preparations for surgery made.

Risk of anal sphincter injury in women undergoing VBAC is 5%.

Birthweight is the strongest predictor of anal sphincter injury in women undergoing VBAC.

The recommended dose is - 3 g intravenous benzylpenicillin be given as soon as possible after the onset of labour  and 1.5 g 4 hourly until delivery.
The first dose should be given at least 4 hours prior to delivery.

- For pregnancies at more than 16 weeks of gestation the term low-lying placenta should be used when the placental edge is less than 20 mm from the internal os on transabdominal or transvaginal scanning (TVS).

If the distance between the internal os and the placental edge is 20 mm or more on TVS, the placental location should be recorded as normal and managed as per routine

• The term placenta praevia should be used when the placenta lies directly over the internal os.

Systemic chemotherapy is contraindicated in the first trimester because of a high rate of fetal
abnormality,but is safe from the second trimester.