Pregnancy and clotting disorders anybody treated with aspirin?

[babycatcher12]

So very long story short, I have had 4 normal healthy pregnancies with no complications. I lost a baby at 15 weeks in December for unknown reasons  and then lost another baby in May at 14 weeks with Turner syndrome. As part of my "workup" they discovered I have prothrombin 2 mutation. I do have an appointment with maternal fetal medicine in August to discuss their recommendations for future pregnancies. My doctor said to expect them to suggest heparin and a repeat c/s (my last live birth was a HBA3C). I'm not crazy about either of those at all. But... my doctor said we may just be chasing our tails here because I've had 4 healthy pregnancies and that the "big gun" interventions may not be needed. Too bad I'm moving 4 hours away in about a month.

There isn't a ton of research on it either way. I'm wondering if anyone has just taken a baby aspirin during pregnancy and maybe some Omega 3s and have been okay. I don't want to ride the high intervention train if I can help it. 

Thoughts? 

Suggestions? 

[Mosaic]

I and other members have used baby aspirin throughout pregnancy for various clotting issues, but mine was different from yours and wouldn't have responded to heparin. I think the repeat c/s after a HBA3C seems unnecessary.... hoping more folks chime in with more experience.

[mariskamom]

I completely understand your wish to avoid the meds. I have a five year old DD. After her I had five miscarriages. The Perinatologist ran a million testsand I came back with two clotting disorders. I agreed to take a combo of lovenox and baby aspirin. I am now 36+weeks! I have no regrets about my decision.

I wonder why they would insist on a c/s? I am switching from lovenox to heparin next week since it is easier to reverse. They want to control the bleeding during delivery but a vaginal delivery usually involves less bleeding than a c/s.

good luck with your appointment.

[LLQ1011]

I doubt the specialist will say c-section. I have a clotting disoirder and asked for a c-section because I was terrified something would happen durring labor because even with the meds the clotting issue can compromise the placenta and I was at risk for abruption.

He refused. Told me that with my condition vaginal was the best way to go. Even when my ob had previously agreed to do a c-section if I wanted. THANK GOD I DIDNT GET ONE THOUGH.

You will be surprised the knowledge gap between the specialist and the ob. It sure taught me that for the most part an ob just has to spin in  a chair for nine months, spend three house watching a vagina and bam they make 25K.

I have only had losses before my son so the lovenox was something I had to take. Second trimester losses are so hard I am so sorry you have to go through this. For me I would do the lovenox again. But since you have had previous sucess maybe aspirin would be enough. The issue is that if its not enough theres not really a way to start the lovenox at a sign of distress. I do not know the nature of your losses. but the specialist will take that into concideration. I have heard of specialists only giving aspirin.

[babycatcher12]

Thanks for your input. My understanding for the suggested repeat c/s is because they won't be able to "manage"my labor with an induction. They usually stop the heparin the day or two before an induced birth. Since I'm a VBAC and can't be induced there's no way to "control" when I stop the heparin. The other thought was that *if* I would rupture I would be at much higher risk for adverse events because I had been on anticoagulants. We'll see though.

Lovenox isn't an option for me because we don't have insurance and I can't afford the $100/shot it costs. So I would be looking at heparin throughout the whole pregnancy. 

I did talk to my homebirth midwife. She said she's had a patient with factor V (which is worse) who just took baby aspirin throughout her pregnancies and is having her 3rd homebirth this next month. So who knows? There is so much conflicting information and no real standard of care for physicians to follow. 

FWIW my loss in December was for unknown reasons and my loss in May has been attributed to Turner Syndrome. I have never had blood clots (PE, DVT etc) and didn't have bleeding issues after my losses other than retained placentas (which I'm told is relatively common with early losses like that since your uterus isn't supposed to give up placentas that early). 

Thanks for the input. Let me know if you have other thoughts or suggestions!

[LLQ1011]

there is a generic enoxoparin i think its called. My insurance didn't cover the lovenox either. Yeah that all sounds crazy to me. I would wait until you talk to a specialist about it. Mine was adament about not having a c-section. I hope your specialist can give you a better evaluation than you got. I had to stop taking my meds only 12 hours prior.  You are right they do normally try to induce. But with my son I had to be induce because of a cloudy ultrasound. It didn't matter when I had taken my meds and he was born 11 hours after the appointment. Have you had vbac's before?

I have also only had second trimester losses 2. I also had retained placenta. But I would think that if you have had previous sucessful pregnancies and no DVT's that aspirin might be totally and option.

Factor five only 50% of people actually have recurrent pregnancy loss. My disorder is at about the same ratio. Its such a wierd thing to work with. I have heard of people managing their clotting through diet too.

When is your specialist appointment? What are you located?

I also want to put that I have an incompetant cervix also. So my pregnancies require a lot more intervention then just lovenox so I can't really say for sure if this one thing saved my son. It could of been the progesterone, the terbutaline, the bed rest, the constant monitoring, the supositories, oeeing in a bed pan I have no idea. My specialist is convinced my cramping and cervical issues is caused by the blood clotting in the placenta irritating my uterus which trigures my losses.

[babycatcher12]

My appointment is August 6. I will be going to Colorado Springs, but shortly after that appointment we will be moving to the middle of nowhere in SW Kansas. I had 3 c/s then a successful HBAC and then my two losses. My second loss was caused by Turner Syndrome we think. There has been no evidence of clotting with either of those births, well with any of them really. Thank you so much for all the helpful advice. There just seems to be so little research and no one clear opinion. :)

I'll be sure to post an update after my appointment. 

[LLQ1011]

Yes keep us updated. I forgot to put too. Not all specialists are created equal either. I had to see 6 before I found one who would work for me.
 

[LLQ1011]

How was your appointment today??

[babycatcher12]

Thanks for asking! I was just coming here to post, thanks for remembering. :)

I had my appointment with MFM this morning. The doc didn't really help all that much. She basically said all of our options are viable and would be okay with any of them. She didn't have a strong recommendation either way. So these are my options (I have MTHFR, which I'm taking extra folate for and Prothrombin 2 mutation)

Option 1. Just take baby aspirin during pregnancy and "attempt" another VBAC

Option 2. Take heparin/lovenox during pregnancy and "attempt" another VBAC

Option 3. Take heparin/lovenox and have a 4th Repeat C/S

Option 4. Take baby aspirin and have 4th Repeat C/S. 

 

She said she usually tries to sway patients one way or the other, but since I've had 4 healthy pregnancies without intervention for the clotting disorder that any of the options would be reasonable to take and she doesn't really have a preference either way. She did say she wouldn't recommend another homebirth, but she said it with a smile and kind of that's what she I'm supposed to do shrug. I do have an appointment with my OB tomorrow. The MFM doc suggested an appointment in the next week or so to check for a heartbeat and then start heparin if we decide to go that route. I think I'm just under 6 weeks so I'm not sure we'll be able to see a heartbeat, but it will at least give me a chance to talk to the doc. 

 

Our decision may be influenced by our ability to get insurance. Right now it's either find a way to fork out the cash for COBRA or self pay because private insurance companies consider pregnancy a pre-existing condition in Kansas and won't cover me. We don't qualify for medicaid because in Kansas they only count the father, mother and baby in utero for family size so the income requirements are much lower than if they considered our entire family size. Basically everyone I called today said they couldn't help me and there weren't other options. :(

[LLQ1011]

I thought there was a law saying that pregnancy cannot be considered a preexisting condition. Those are a lot of choices. I have heard a lot of sucess with just baby aspirin. It eliminates 98% of the platlets. Its so hard to chose what is right. I think as long as you have no break in health coverage they cannot consider any preexisting conditon. Maybe the cobra for a month just until you can get private healthcare. Kansas has stupid rules.

I will be thinking about you and your little baby for the next 8 months! Keep us updated. :)

[babycatcher12]

The law for pre-existing conditions doesn't kick in until 2014 for private insurance companies. Neither of the jobs DH will be working offers group insurance so we're buying it privately. I had an appointment and early sono on Tuesday. We found a heartbeat (yay!) But also a SCH that is 3cm long and 1cm deep. So the doc said no aspirin and no heparin until around 11-12 weeks. We want platelets to be working so the SCH doesn't get bigger. We'll be moving in 11 days so I'll be looking for another provider unless we want to drive the 4 hours to see my current provider. 

I'm truly at a loss. That's just all I can say. I'm at a loss. 

[LLQ1011]

That is so rough. Stupid SCH! STUPID INSURANCE!

If i could hug you I would, and somehow give you my canadian insurance for the next year.

STAY WITH YOUR MAMA LITTLE BABY!!!