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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.

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

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

• 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.

According to Guidance from the British Committee
for Standards in Haematology, it is greater than 2 gram/dL

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

Pregnant women with red cell antibodies, who are assessed as being at high risk of requiring a blood transfusion, should have a cross-match sample taken at least every week.

Current BCSH guidelines require a sample no more than 72 hours old for providing compatible blood in
pregnancy,but do allow a deviation to the 3-day rule for individual cases such as high-risk women with placenta praevia without red cell antibodies where weekly samples can be taken, as long as a risk assessment is made and recorded in each individual case

In high-risk women with red cell antibodies where a sample every 72 hours is not feasible, a sample should be taken once a week and if transfusion is required a new sample should be taken immediately, to exclude new antibody development. However, in the event of life threatening haemorrhage, urgent transfusion should not be delayed and close liaison with the hospital transfusion laboratory is vital.

Treatment with therapeutic doses of subcutaneous LMWH should be employed during the remainder of the pregnancy and for at least 6 weeks postnatally and until at least 3 months of treatment has been given in total.