Active management of Third stage of Labor includes -

1. Administer 10 IU of oxytocin by intramuscular injection with the birth of the anterior shoulder or immediately after the birth of the baby and before the cord is clamped and cut.

2. After administering oxytocin, clamp and cut the cord- Do not clamp the cord earlier than 1 minute from the birth of the baby unless there is concern about integrity of the cord, or well being of the baby ( e.g heart rate below 60 bpm AND not getting faster) .
Clamp the cord before 5 minutes.

3. After cutting the cord, use controlled cord traction- only after administration of oxytocin and signs of separation of the placenta.

Conversion from LMWH back to warfarin should be delayed for at least 5 to 7 days after delivery
to minimise the risk of haemorrhage during the period of overlap of LMWH and warfarin treatment.

- For pregnancies at more than 16 weeks of gestation the term low-lying placenta should be used when the placental edge is less than 20 mm from the internal os on transabdominal or transvaginal scanning (TVS).

• The term placenta praevia should be used when the placenta lies directly over the internal os.

The algorithm suggested by RCOG for low lying placenta can be accessed HERE 

With Remifentanyl PCA- Respiratory depression is reported in up to 32% of patients and
oxygen saturations below 90% are seen in about 5%.

Some suggested contraindications of Remifentanyl PCA include- morbid obesity, clinical features of a chest infection and primigravida women who are at risk of prolonged labour.

• 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

Aspirin is not recommended for thromboprophylaxis in obstetric patients.

• Offer bladder training lasting for a minimum of 6 weeks as first-line treatment to women with urgency or mixed urinary incontinence.
• 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.
• Offer a face-to-face or telephone review 4 weeks after starting a new medicine for overactive bladder