Planned VBAC is associated with an approximately 1 in 200 (0.5%)
risk of uterine rupture

The six elements considered to be reflective of good care are:
 Consultant obstetrician planning and directly supervising delivery.
 Consultant anaesthetist planning and directly supervising anaesthesia at delivery.
 Blood and blood products available.
 Multidisciplinary involvement in preoperative planning.
 Discussion and consent, including possible interventions (such as hysterectomy, leaving the placenta in situ, cell
salvage and interventional radiology).
 Local availability of a level 2 critical care bed.

According to the RCOG- Any lack of compliance with the care bundle by the clinical team for a woman with either placenta praevia or accreta
should be investigated.

According to MBBRACE-UK 2014 to 2016- Women who have had a previous caesarean section who also have either placenta praevia or an anterior placenta underlying the old caesarean section scar at 32 weeks of gestation are at increased risk of placenta accreta and should be managed as if they have placenta accreta, with appropriate preparations for surgery made.

People who are concerned about their fertility should be informed that over
80% of couples in the general population will conceive within 1 year if:
- the woman is aged under 40 years and
- they do not use contraception and have regular sexual intercourse.
Of those who do not conceive in the first year, about half will do so in the second year
(cumulative pregnancy rate over 90%).

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.

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.

For anti-K antibodies, referral should take place once detected, as severe fetal anaemia can occur even with low titres.