NSAIDs can lead to neonatal pulmonary hypertension and premature closure of the ductus arteriosus.

NSAIDs also reduce fetal renal blood flow and thus urine production leading to a reduced amniotic fluid volume.

The use of NSAIDs should, therefore, be avoided at more than 30 weeks of gestation.

In the first stage of labour, pain is transmitted via
the spinal nerves of T10–L1 and results from uterine
contractions and dilatation of the cervix. In the second
stage, stretching of the pelvic ligaments causes pain via the
pudendal nerve originating from the S2–S4 nerve roots.

In women with suspected PE who also have symptoms and signs of DVT, compression duplex ultrasound should be performed. If compression ultrasonography confirms the presence of DVT, no further investigation is necessary and treatment for VTE should continue.

Pregnant women with suspected PE who have symptoms and signs of DVT should have bilateral compression duplex ultrasound leg studies performed. A diagnosis of DVT may indirectly confirm a diagnosis of PE and since anticoagulant therapy is the same for both conditions, further investigation may not be necessary.

This would limit the radiation doses given to the mother and her fetus.

The algorithm suggested by the RCOG can be viewed HERE

In clinically suspected DVT or PE, treatment with low-molecular-weight heparin (LMWH) should be commenced immediately until the diagnosis is excluded by objective testing, unless treatment is strongly contraindicated.

Compression duplex ultrasound should be undertaken where there is clinical suspicion of DVT.
If ultrasound is negative and there is a low level of clinical suspicion, anticoagulant treatment can be discontinued.

If ultrasound is negative and a high level of clinical suspicion exists, anticoagulant
treatment should be discontinued but the ultrasound should be repeated on days 3 and 7.

Intravenous unfractionated heparin is the preferred, initial treatment in massive PE with cardiovascular compromise.

There are no firm criteria for initiating red cell transfusion. The decision to provide blood transfusion should be based on both clinical and haematological assessment.

The 2009–12 Confidential Enquiries into Maternal Deaths and Morbidity report3 highlighted the importance
of correlating clinical signs and symptoms expected from different blood loss values to help target decisions on resuscitation, and also emphasised the importance of taking the woman’s weight into account.

The therapeutic target in case of massive blood loss is to maintain Haemoglobin  greater than 8 gm/dL.