CTPA delivers a low radiation dose to the fetus

According to the RCOG Guideline- until blood is available, infuse up to 3.5 l of warmed clear fluids, initially 2 l of warmed isotonic crystalloid.

• Further fluid resuscitation can continue with additional isotonic
  crystalloid or colloid (succinylated gelatin).
• Hydroxyethyl starch should not be used.
•  The best equipment available should be used to achieve rapid warmed infusion of fluids

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.

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)

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

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