Family history of pulmonary embolism - Mothering Forums
 
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#1 of 5 Old 05-18-2009, 10:24 PM - Thread Starter
 
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I'm not sure exactly if this would be better posted in the birth professionals forum. I'm interested in hearing from anyone with personal experience, though.
Long story short, in the past four years both my mother (in Canada) and my aunt (her sister, living in England) have suffered pulmonary embolisms following minor surgeries. Although it was very serious and scary in both cases, both of them fortunately made a full recovery. Both now will only need to take blood thinners in certain situations (eg. before flying), rather than at all times.
My Aunt's embolism happened a few weeks ago. She has a daughter a few years older than me. Her daughter was advised by her GP that due to her mother's embolism, she is considered at greater risk for blood clots. She was taken immediately off the Pill, which she had been taking for years. She was then referred to a specialist, who told her that she could never go on hormonal birth control again, but more worryingly that if she were to fall pregnant, she would immediately be considered high-risk and would be very closely monitored. She informed the specialist that she had already had two children with straightforward pregnancies, and the specialist replied that she was extremely lucky.
Now, I'm obviously quite concerned. I have the same family history as my cousin, and I had never even considered that I could be at higher risk for a blood clot in pregnancy.
My midwives don't know about my mom's embolism, they have never asked and since it was four years ago, I never thought to mention it. It's something I would have brought up if I was ever facing surgery, but it never occurred to me that my midwives would need to know.
I don't know if this is something I should talk to them about ASAP, or if it can wait 2 weeks until my next appointent. I'm also wondering if this means there will be changes in my care and birth plans. I know that there are differences in prenatal care regulations between England and Ontario, but from what I understand the standards are pretty similar with midwifery care being encouraged and all.
Does anyone have any experience or advice? i'm terrified with every ache and pain now :

Me + him = DS 01/08 & DD 09/09 X2
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#2 of 5 Old 05-19-2009, 01:15 AM
 
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I would think the easy place to start would be testing for inherited thrombophilias. I'm surprised your mother isn't having this kind of testing, but then with a history of PE perhaps it doesn't matter, in the sense that she'll get anticoagulants when necessary anyway.

You could be tested by a hematologist or a perinatologist. It's just a blood test. If something turns up, the usual treatment is prophylactic anticoagulation during pregnancy and growth checks via u/s.

Personally, I'd mention it to your midwives, especially since both your mother and your aunt had PEs - makes it more likely that there would be an inherited clotting issue as opposed to their clots being random events. Most docs ask for family history that includes blood clotting, though sometimes it's not quite that specific, so it didn't trigger your memory.

My mom had a DVT (we both have heterozygous FVL) and I doubt I would have been anticoagulated on the basis of her DVT alone. So it may be well worth it to find out if there is a genetic issue.

here's a site with some info about some of the inherited thrombophilias
www.fvleiden.org

good luck!
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#3 of 5 Old 05-19-2009, 02:06 AM
 
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Moved to Health and Healing.

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#4 of 5 Old 05-19-2009, 02:24 PM
 
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Pretty much exactly what snowmom wrote.

I also have factor v leiden (heterozygote). I have also had a previous DVT. Because of this, and NOT because of the factor v leiden, I have to take heparin injections throughout pregnancy and beyond and have more frequent doctor visits (though my visits are usually quick and easygoing. no stress). If I hadn't had the DVT, I wouldn't be on the injections, pure and simple.

The risks during pregnancy, besides DVT, are clots on the placenta and so a higher risk of miscarriage. But the fact that your sister and yourself have both had pregnancies without problems is a great sign and I wouldn't worry too much. The babies riskiest time is during the first 20 weeks or so. And then the risky period is for you in the weeks in the run up to the birth and especially 6-8 weeks afterwards. If you were worried at all, that would be the time to consider blood thinners.

As for homebirths, I live in Ireland and due to my past history of DVT and the fact that I had thrombophlebitis (enlarged veins and the beginning of a clotting episode) up until around 22 weeks with this pregnancy, has risked me out of having one (in regards to the regulations we have here). If I had no history of clots, I could still have one.

I do agree that it is in your best interest, and your sisters, to get tested for clotting disorders. The likelihood is that your mum and aunt have one (in fact I'd say it is fairly certain) and so either of you could also have one.
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#5 of 5 Old 05-19-2009, 06:28 PM
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I also have FVL. I had two great pregnancies/births without thinners.

You may want to consider postpartum blood thinner, though. That 6 week period is when you are most likely to clot.

"Our task is not to see the future, but to enable it."
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