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

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

Non-hormonal contraceptive methods are recommended.

According to UKMEC- For women with 'Current breast cancer' , Cu IUCD is Category 1 , all other contraceptive methods are category 4.

For women with 'Past' breast cancer' , Cu IUCD is Category 1 , all other contraceptive methods are category 3.

• Anthracyline regimens are safe
• There are fewer data on taxanes, which should be reserved for high-risk (node-positive) or metastatic disease.
• Tamoxifen is not used until after delivery.
• Trastuzumab  is contraindicated during pregnancy.
• Haemopoietic growth factors (granulocyte colony stimulating factor) may be employed to ameliorate chemotherapy-induced neutropenia.

• 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.

• 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.

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.

- 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).

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

The algorithm suggested by RCOG for low lying placenta can be accessed HERE 

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.

Conception during tamoxifen therapy should be avoided because
of potential teratogenicity, and a ‘washout period’ of 2–3 months is advised

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.