Obstetric patients who are postoperative and receiving unfractionated heparin should have platelet count monitoring performed every  2 to3  days from days 4 to 14 or until heparin is stopped.

The platelet count should be checked after 24 hours of initiating treatment if the patient has previously received heparin (unfractionated or LMWH) in the last 100 days.

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.

• 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

- 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).

If the distance between the internal os and the placental edge is 20 mm or more on TVS, the placental location should be recorded as normal and managed as per routine

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

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)

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

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

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

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.