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.

The methods that have been shown to be effective are-

1.  Epidural
2.  Combined spinal–epidural
3.  Continuous one-to-one support                                                                                                          ( Cochrane Database Syst Rev 2012;(3):CD009234)

;WD,W

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.

This is a question indeed-

• Before anticoagulant therapy is commenced, blood should be taken for a full blood count, coagulation screen, urea and electrolytes, and liver function tests.
• Performing a thrombophilia screen prior to therapy is not recommended.
• D-dimer testing should not be performed in the investigation of acute VTE in pregnancy. ( D Dimer levels are usually high in pregnancy).
• Compression duplex ultrasound should be undertaken where there is clinical suspicion of DVT.If ultrasound is negative and a high level of clinical suspicion exists, anticoagulant treatment should be discontinued but the ultrasound should be repeated on days 3 and 7.If ultrasound is negative and there is a low level of clinical suspicion, anticoagulant treatment can be discontinued.
• Women presenting with symptoms and signs of an acute PE should have an electrocardiogram (ECG) and a chest X-ray (CXR) performed

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%).

Treatment with therapeutic doses of subcutaneous LMWH should be employed during the remainder of the pregnancy and for at least 6 weeks postnatally and until at least 3 months of treatment has been given in total.

Where delivery is planned, either by elective caesarean section or induction of labour, LMWH maintenance therapy should be discontinued 24 hours prior to planned delivery.

Regional anaesthetic or analgesic techniques should not be undertaken until at least 24 hours
after the last dose of therapeutic LMWH.
LMWH should not be given for 4 hours after the use of spinal anaesthesia or after the epidural catheter has been removed, and the epidural catheter should not be removed within 12 hours of the most recent injection.

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