The contraindications/Cautions are-

• Known bleeding disorder (e.g. haemophilia, von Willebrand’s disease or acquired coagulopathy)
• Active antenatal or postpartum bleeding
  - Women considered at increased risk of major haemorrhage (e.g. placenta praevia)
  - Thrombocytopenia (platelet count < 75 × 109/l)
  - Acute stroke in previous 4 weeks (haemorrhagic or ischaemic)
  - Severe renal disease (glomerular filtration rate [GFR] < 30 ml/minute/1.73m2)
  - Severe liver disease (prothrombin time above normal range or known varices)
  - Uncontrolled hypertension (blood pressure > 200 mmHg systolic or > 120 mmHg diastolic)
•  ( In case of any doubt, a haematologist review should be sought)

• 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

Undertake a urine dipstick test in all women presenting with urinary
incontinence to detect the presence of blood, glucose, protein, leucocytes and nitrites in the urine.

After undertaking a detailed clinical history and examination, perform
multichannel filling and voiding cystometry before surgery for stress urinary
incontinence in women who have anterior or apical prolapse.

Before surgery- an MDT should review the proposed treatment. And before surgery, women should be asked for consent for their data to be entered in a national registry.

Regional techniques should be avoided if possible until at least 12 hours after the previous prophylactic dose of LMWH.

Women receiving antenatal LMWH having an elective caesarean section should receive a thromboprophylactic dose of LMWH on the day prior to delivery and, on the day of delivery, any morning dose should be omitted and the operation performed that morning.

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.

• LMWHs are the agents of choice for antenatal and postnatal thromboprophylaxis.
  - Doses of LMWH are based on weight.
• For thromboprophylaxis the booking or most recent weight
  can be used to guide dosing

• Measure post-void residual volume by bladder scan or catheterisation in women with symptoms suggestive of voiding dysfunction or recurrent UTI.
• Use a bladder scan in preference to catheterisation on the grounds ofacceptability and lower incidence of adverse events.
• Undertake a urine dipstick test in all women presenting with urinary incontinence.
• Undertake routine digital assessment to confirm pelvic floor muscle contraction before the use of supervised pelvic floor muscle training for the treatment of urinary incontinence.

Do not use the Q-tip, Bonney, Marshall and Fluid-Bridge tests in the assessment of women with urinary incontinence.