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.

Advise women with urinary incontinence or overactive bladder who have a BMI greater than 30 to lose weight.

Offer a trial of supervised pelvic floor muscle training of at least 3 months'
duration as first-line treatment to women with stress or mixed urinary
incontinence.Pelvic floor muscle training programmes should comprise at least 8 contractions performed 3 times per day.

Do not use perineometry or pelvic floor electromyography as biofeedback as a routine part of pelvic floor muscle training.

• 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.

;WD,W

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.

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

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

Cryoprecipitate should be used for fibrinogen replacement.

Fibrinogen loss can be replaced by cryoprecipitate or fibrinogen concentrate .

But fibrinogen concentrate is not licensed for acquired hypofibrinogenaemia in the UK.

• If pharmacological measures fail to control the haemorrhage, surgical interventions should be initiated sooner rather than later.
• Intrauterine balloon tamponade is an appropriate first-line ‘surgical’ intervention for most women where uterine atony is the only or main cause of haemorrhage.