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 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.

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

If the placenta is thought to be low lying (less than 20 mm from the internal os) or praevia
(covering the os) at the routine fetal anomaly scan, a follow-up ultrasound examination
including a TVS is recommended at 32 weeks of gestation to diagnose persistent low-lying
placenta and/or placenta praevia.

Use of TVS- to accurately see the placental edge. Also, cervical length is a predictor of antepartum bleeding and emergency preterm caesarean section in placenta praevia. Women with a cervical length of less than 31 mm have a 16 times higher risk of emergency
caesarean section due to massive haemorrhage.

- 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.

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

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.

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

• 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.

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.

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.

Read about Intrapartum Care in VBAC-

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

Women are generally advised to wait for at least 2 years after treatment for breast cancer before
conception.