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

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.

• If the history suggests that the reaction described is not likely to be allergic in nature then penicillin should be given.
• If the history suggests an allergy to beta-lactams, but one that is not severe(i.e. no anaphylaxis, angioedema, respiratory distress or urticaria), then a cephalosporin can be administered.
• If the allergy to beta-lactams is severe then intravenous vancomycin is recommended.

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

GBS is present in the bowel flora of 20–40% of adults (this is called ‘colonisation’). People who are colonised are called
‘carriers’. This includes pregnant women (there is no evidence that its carriage rate is specifically affected by pregnancy).

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.

• 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.

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

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)

Cord presentation is the presence of the umbilical cord between the fetal presenting part and the cervix, with or without intact membranes. ( i.e if the cord  is present ABOVE the cervix, with ruptured membranes- this is cord PRESENTATION)

Cord prolapse is descent of the umbilical cord through the cervix  in the presence of ruptured membranes.

Cord prolapse can be occult ( Alongside the presenting part) or OVERT (Past the presenting part)

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.

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. 

TELL US HOW WE ARE DOING- CLICK HERE

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.