Undertake a urine dipstick test in all women presenting with urinary
incontinence to detect the presence of blood, glucose, protein, leucocytes and nitrites in the urine.

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)

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.

• 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

A statement from the FDA was issued following the publication of two case reports28,29 linking first trimester use of opioids to increased neural tube defects. It was concluded that the opioid use was linked to a small increase in neural tube defects, although evidence was limited and further research is needed.

In women at very high risk of thrombosis , UFH may be used peripartum in
preference to LMWH where there is an increased risk of haemorrhage or where regional anaesthetic techniques may be required.

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.

Checking the environment is THE FIRST STEP. Who knows the patient has been electrocuted from a faulty electric wire ! Touching her without assessing the environment can harm the healthcare provider.

If women do not achieve satisfactory benefit from bladder training programmes, the combination of an overactive bladder medicine with bladder training should be considered if frequency is a troublesome symptom.