• LMWH should not be given for 4 hours after use of spinal anaesthesia or after the epidural catheter has been removed
• and the catheter should not be removed within 12 hours of the most recent injection.

The Green Top Guidleine 37 a  ( VTE Prevention in Pregnancy and Puerperium) has very useful charts for VTE risk assessment-  these can be downloaded HERE

• Anthracyline regimens are safe
• There are fewer data on taxanes, which should be reserved for high-risk (node-positive) or metastatic disease.
• Tamoxifen is not used until after delivery.
• Trastuzumab  is contraindicated during pregnancy.
• Haemopoietic growth factors (granulocyte colony stimulating factor) may be employed to ameliorate chemotherapy-induced neutropenia.

Non-hormonal contraceptive methods are recommended.

According to UKMEC- For women with 'Current breast cancer' , Cu IUCD is Category 1 , all other contraceptive methods are category 4.

For women with 'Past' breast cancer' , Cu IUCD is Category 1 , all other contraceptive methods are category 3.

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

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

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.

Where delivery is planned, either by elective caesarean section or induction of labour, LMWH maintenance therapy should be discontinued 24 hours prior to planned delivery.

Regional anaesthetic or analgesic techniques should not be undertaken until at least 24 hours
after the last dose of therapeutic LMWH.
LMWH should not be given for 4 hours after the use of spinal anaesthesia or after the epidural catheter has been removed, and the epidural catheter should not be removed within 12 hours of the most recent injection.

Regarding 'Prophylactic dose'-Regional techniques should be avoided if possible until at least 12 hours after the previous
prophylactic dose of LMWH.
LMWH should not be given for 4 hours after use of spinal anaesthesia or after the epidural catheter has been removed and the catheter should not be removed within 12 hours of the most recent injection.