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Systemic chemotherapy is contraindicated in the first trimester because of a high rate of fetal
abnormality,but is safe from the second trimester.

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.

Codeine is converted to active metabolites, mainly morphine. The ultrarapid metaboliser phenotype is due to duplications of the CYP2D6 gene, and prevalence varies by ethnic origin.

Ultrarapid metabolisers who take codeine can have up to 50% higher plasma concentrations
of its active metabolite morphine than extensive metabolisers, with the consequence that there is a risk of serious toxicity even at therapeutic doses of codeine in such individuals.

Planned VBAC is contraindicated in women with previous uterine rupture or classical caesarean scar.

Women who have had two or more prior lower segment caesarean deliveries may be offered VBAC after counselling by a senior obstetrician. This should include the risk of uterine rupture and maternal morbidity, and the individual likelihood of successful VBAC.

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

Up to 10% of women scheduled for ERCS go into labour before
39+0 weeks. Therefore it is good practice to to discuss and document a plan for delivery if labour starts prior to the scheduled date.

• 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

Successful VBAC is more likely among women with previous caesarean for
fetal malpresentation (84%) compared with women with previous caesarean for either labour dystocia (64%) or fetal distress (73%) indications.