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

Methotrexate adjuvant therapy should not be used for expectant management as it is of unproven benefit and has significant adverse effects.

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.

When testing for GBS carrier status, a swab should be taken from the lower vagina and the anorectum.

A single swab (vagina then anorectum) or two different swabs can be used.

The RAADP scheme should be regarded as supplementary to any anti-D Ig administered for sensitising episodes.

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

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

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

Previous vaginal delivery, particularly previous VBAC, is the single best predictor of successful VBAC and is associated with a planned VBAC success rate of 85–90%.

Previous vaginal delivery is also independently associated
with a reduced risk of uterine rupture.

A systematic review reported that women with one, two, or three or more previous caesarean deliveries experience a 1%, 1.7% or 2.8% risk of placenta previa in a subsequent pregnancy. ( Source- Birth After Previous
Caesarean Birth Green-top Guideline No. 45 ).

Assisted reproductive technology ( RR- 3.71, OR 2.67)and maternal smoking ( OR 1.42)  increase the risk of placenta praevia.

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.

It should be done at 32–34 weeks of gestation for women with twins.

The recommended time of testing is 3–5 weeks prior to the anticipated delivery date- therefore  35–37 weeks of gestation in singleton pregnancies with no risk factors for preterm delivery.

Up to 10% of women scheduled for ERCS go into labour before
39+0 weeks. Therefore it is good practice to to discuss and document a plan for delivery if labour starts prior to the scheduled date.