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

• IAP( Intrapartum antibiotic prophylaxis)  is recommended for women in confirmed preterm labour.  The risk of GBS infection is higher with preterm delivery and the mortality rate from infection is increased (20–30% versus 2–3% at term). For this reason, IAP is recommended for women in confirmed preterm labour.
• There is no evidence that intrapartum vaginal cleansing will reduce the risk of neonatal GBS disease.
• Polymerase chain reaction or other near-patient testing at the onset of labour is not recommended.

• 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.

• 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.

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. 

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

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

Read about Intrapartum Care in VBAC-

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

It is not necessary to administer anti-D Ig to D negative females without childbearing potential, or males who receive D positive platelets.

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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.

The likelihood of maternal GBS carriage in this pregnancy is 50%.
What should be done?- Discuss the options- a. Intrapartum antibiotic prophylaxis ( IAP).
b. Bacteriological testing in late pregnancy and the offer of IAP if still positive. ( This is the only group of women who are eligible for GBS screening funded by NHS)

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