• Anthracyline regimens are safe
• There are fewer data on taxanes, which should be reserved for high-risk (node-positive) or metastatic disease.
• Tamoxifen is not used until after delivery.
• Trastuzumab  is contraindicated during pregnancy.
• Haemopoietic growth factors (granulocyte colony stimulating factor) may be employed to ameliorate chemotherapy-induced neutropenia.

• The timing of delivery should be tailored to the patient.
• If history of vaginal bleeding/ other risk factors for preterm delivery- consider ‘Late preterm delivery’- 34+0 to 36 +6 weeks.
• If uncomplicated placenta previa- Consider between 36+ 0 and 37+0.

Read about Intrapartum Care in VBAC-

https://obgresource.com/2021/12/10/intrapartum-care-in-vbac-2/

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.

Use bladder diaries in the initial assessment of women with urinary
incontinence or overactive bladder.

Encourage women to complete a minimum of 3 days of the diary covering variations in their usual activities, such as both working and leisure days.

If the placenta is thought to be low lying (less than 20 mm from the internal os) or praevia
(covering the os) at the routine fetal anomaly scan, a follow-up ultrasound examination
including a TVS is recommended at 32 weeks of gestation to diagnose persistent low-lying
placenta and/or placenta praevia.

Use of TVS- to accurately see the placental edge. Also, cervical length is a predictor of antepartum bleeding and emergency preterm caesarean section in placenta praevia. Women with a cervical length of less than 31 mm have a 16 times higher risk of emergency
caesarean section due to massive haemorrhage.

• Offer bladder training lasting for a minimum of 6 weeks as first-line treatment to women with urgency or mixed urinary incontinence.
• If women do not achieve satisfactory benefit from bladder training programmes, the combination of an overactive bladder medicine with bladder training should be considered if frequency is a troublesome symptom.
• Offer a face-to-face or telephone review 4 weeks after starting a new medicine for overactive bladder

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.