• 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.

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.

- 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.

Antenatal thromboprophylaxis for those with previous VTE should begin as early in pregnancy as practical.

Women with previous VTE should be offered prepregnancy counselling, and a  prospective management plan for thromboprophylaxis in pregnancy should be made. Those who become pregnant beforemreceiving such counselling should be referred at the earliest opportunity in pregnancy to a clinician
with expertise in thrombosis in pregnancy.

Well done for taking the quiz ! Small steps taken everyday make a huge difference.

Use of UFH predisposes patients to thrombocytopenia..

Obstetric patients who are postoperative and receiving unfractionated heparin should have platelet count monitoring performed from days 4 to 14 ,

or until heparin is stopped.

The correct answer is- 11 g/ 100 ml at first contact and 10.5 g/100 ml at 28 weeks.

Haemoglobin outside this range should be investigated and iron supplementation considered if indicated.

Pregnant women should be offered screening for anaemia. Screening should
take place early in pregnancy (at the booking appointment) and at 28 weeks
when other blood screening tests are being performed. This allows enough time
for treatment if anaemia is detected.

Source- 1. NICE  Antenatal care for uncomplicated
pregnancies
Clinical guideline
Published: 26 March 2008

2. RCOG Green-top Guideline No. 52