Women can be reassured that long-term survival after breast cancer is not adversely
affected by pregnancy.

• LMWHs are the agents of choice for antenatal and postnatal thromboprophylaxis.
  - Doses of LMWH are based on weight.
• For thromboprophylaxis the booking or most recent weight
  can be used to guide dosing

The methods that have been shown to be effective are-

1.  Epidural
2.  Combined spinal–epidural
3.  Continuous one-to-one support                                                                                                          ( Cochrane Database Syst Rev 2012;(3):CD009234)

After undertaking a detailed clinical history and examination, perform
multichannel filling and voiding cystometry before surgery for stress urinary
incontinence in women who have anterior or apical prolapse.

Before surgery- an MDT should review the proposed treatment. And before surgery, women should be asked for consent for their data to be entered in a national registry.

• Warfarin use in pregnancy is restricted to the few situations where heparin is considered unsuitable,e.g. some women with mechanical heart valves.
• Women with previous VTE associated with antithrombin deficiency (who will often be on long-term
  oral anticoagulation) should be offered thromboprophylaxis with higher dose LMWH (either 50%,
  75% or full treatment dose)
• Danaparoid is a heparinoid that is mostly used in patients intolerant of heparin, either because of HIT or a skin allergy to heparins

Antenatal thromboprophylaxis for those with previous VTE should begin as early in pregnancy as practical.

Women with previous VTE should be offered prepregnancy counselling, and a  prospective management plan for thromboprophylaxis in pregnancy should be made. Those who become pregnant beforemreceiving such counselling should be referred at the earliest opportunity in pregnancy to a clinician
with expertise in thrombosis in pregnancy.

Well done for taking the quiz ! Small steps taken everyday make a huge difference.

• Clinicians should consider the use of intravenous tranexamic acid (0.5–1.0 g), in addition to oxytocin, at caesarean section to reduce blood loss in women at increased risk of PPH.
• Consideration should be given to the use of tranexamic acid in the management of PPH.
• According to a Cochrane review- blood loss greater than 400 or 500 ml was less
  common in women who received tranexamic acid in addition to the usual uterotonic agent after vaginal
  birth or caesarean section in a dosage of 1 or 0.5 g intravenously. Tranexamic acid was effective in
  decreasing the incidence of blood loss greater than 1000 ml in women who had undergone caesarean section but not vaginal birth. Further studies are required to investigate the risk of serious adverse effects, including thromboembolic events.

Use of UFH predisposes patients to thrombocytopenia..

Obstetric patients who are postoperative and receiving unfractionated heparin should have platelet count monitoring performed from days 4 to 14 ,

or until heparin is stopped.