[Caroline]

I have a question after reading some more on the web on Protein S deficiency (I was finally diagnosed this pregnancy at 8 wks.). I am currently injecting Lovenox and was told that following my baby's birth (in a few more weeks) that I would be stopping the medication. However, now I am questioning this because I am reading a lot of sources that say your risk is even higher of a blood clot AFTER the birth. Because I had a placental abruption AND severe hemoraging my last birth I am thinking I would be someone that would need to taper off the Lovenox and not just abruptly stop the medication. Oh, and I was also was on bedrest during first trimester for baby #3 due to a blood clot on the gestational sac (daughter was close to not making it here twice actually).

Does anyone have a resource for this that I can print off and show my OB/midwife practice? It's not like I want to keep using Lovenox but I just have this feeling in the back of my mind that it's not going to be so simple as to just stop the injections. But it may also just be that I am getting scared because whether I realize it or not my body remembers the experience of the abruption and hemorage -- it was very scary and a long recovery. Everything has been great up until this point but I still feel worried at times due to my m/c's and last birth experience.

Thanks for any input, Caroline

 

[Scrubsjm]

Sorry I don't have any good resources for you but I had to continue my Lovenox until 6 weeks pp. I only had to do one inj a day during the pp period though. So did a friend of mine who also did Lovenox during pregnancy.

 

[5thAttempt]

Thanks for posting it. Actually I have 20 weeks to go and I am as confused as you. Originally fertility specialist told me to use lovenox till the very end and then a while after. Same for peri I saw. However my OB practice - and they are the ones who will deliver my baby - (I talked to 2 dr out of 4 in this practice) suggested that I go off the lovenox at 36 weeks to reduce comlication with delivery. In any case this is very conflicting point of view.

I also have PSD but I never had a clot, it was discovered during testing for my recurrent m/c.

Can I ask you how come they tested you while you were already pregnant? Did you develop a clot at 8 weeks? Also what do they suggest you to do at the time of delivery - when to stop lovenox?

Sorry, I do not have anything to say but I will be watching this post closely.

 

[sarah9774]

There is a board called yahoo groups FVL that has lots of research and info for all clotting d/o's I have Prothrombin Factor II Mutation and will have to take the shots 6 weeks after I deliver.. so says my Specialist and Hemo. hope this helps..

 

[Caroline]

Seems like so far most of you have are will be using the meds through 6 wks. post-partum. I will definitely be asking questions at my appt. on Friday w/ midwife.

5th attempt, it's a long story but I will try to summerize. I went through a few years of infertility beginning in 2001 (I was 32 yrs. old). At that time I wasn't getting pregnant on my own at all and ended up doing an IUI then over the course of 3 more yrs., 4 IVF's which brought us our 3rd child (!). A year before she was conceived we miscarried twins after IVF #1 (a VERY low point for me). We did chromosomal testing on the second twin and she was found to have trisomy 14. Because of my "so-so" egg quality up until that point, endometriosis (stage II which I had surgery for in '02), and only one functioning tube, all 3 of the RE's I saw during those years never even testing for clotting issues.

After having our third baby we were happy and weren't trying to even conceive another child but much to our surprise I became pregnant 4 times on our own in the last year and a half following her birth. Our youngest DD is now 2.5 yrs. old. Sadly, I miscarried 3 times (the dates are listed in my signature below) and finally made an appt. with my RE again and she prescribed progesterone because my levels were showing to be extrememly low -- so we thought that progesterone levels and age were the main reason for my losses (of course my RE also felt that breastfeeding my 2 yr. old was to blame also but I ignored that part). The progesterone seemed to work during those first few weeks and I went to an OB at 8 weeks that FINALLY thought it would be a good idea to do a complete blood work up and see if there was something the RE was missing. The protein S results were extremely low, and although we knew that during pregnancy is not the best time to check since pregnancy suppresses the level, it was low enought to send me to a hemotologist for a diagnosis.

The Hemo put me on the Lovenox immediately after doing his own bloodwork and then sent me to the maternal-fetal specialist guy. So I have been seeing the MFS and my midwife/OB practice the entire pregnancy.

One thing that was interesting this time also was that I was taking fish oil when I got pregnant and through first trimester which is a natural blood thinner --- I wonder if that helped me get all the way to 8 weeks when I finally got the PSD diagnosis?

Anyway, that's my "short version" of my story, LOL! I cannot tell you how excited we are to be having this baby. We feel like the luckiest people on the planet --- it's been a long road. I am so ready to meet this baby.....just a couple more weeks....

All the best, Caroline

 

[5thAttempt]

Thanks, Caroline.

Are your doctors suggest you to stop lovenox before a delivery? When? Are you planning to be induced? Or switching to heparin?

One of my options is to stop completly at 36 weeks (I am not sure if I want to do that). The othe option stop it 24 hr before delivery and get induced (in case I want to have an epidural or we need to do an emergency c-section for whatever reason. Otherwise it will be general for c-section). My peri mentioned that if I switch to heparin then they can do epidural since it is taken out of the system sooner).

 

[VikiL]

Sorry to yell, but if you are using Lovenox you should be under the care of a perinatologist who measures any placental clots every two weeks and be getting blood tests AT LEAST once a month.
There have been people who lose babies in the last month due to clots.
Thrombophilia is also a cause of preterm labor, which can cause prematurity, and loss. Learned the hard way on that one.
Also, if you have it, get Hubby tested, because you may have to up dosage or injections if baby is outputting to the placenta.
If your OB says don't worry---DO.
Get at least a hemotologist you will see the week after birth for your health and someone who knows what they are doing for your babies.

 

[Caroline]

I have been to a hemotologist -- he prescribed the Lovenox for my PSD. I also see a maternal-fetal specialist (Peri) every four weeks for scans along with my regular OB care.

I have an appt. with the Peri on Monday 8/28 and planned to bring this up with him but was just posting to get feed back (wondering what the "norm" was for women with clotting disorders following the birth). I had my OB/midwife appt. on Friday and she actually confirmed what everyone else had said about the 6 weeks post-partum on Lovenox.

I have to remember when I post "quick posts" that a lot of information is left out and that can make people react strongly. I appreciate your "yelling" though because I agree that if I was uninformed about my clotting disorder I would want someone to let me know how much risk there was with clots at the end of a pregnancy in particular. So thanks, you have the right intentions.

 

[Caroline]

I am going ahead with the plan to stop the Lovenox then have an induction right away. Because I also hemoraged during my last birth I don't want to risk being on the Lovenox during the birth. I plan to go without an epidural and have heard that Pit contractions will be very strong -- I expect a hard labor but know I can handle it. I have also heard that switching to the heparin at the end gives women the option of having an epidural because there is a "reversal agent" for Heparin but not the Lovenox. Or of course, you could just stop the Lovenox then have an induction with the epidural if you want that option. You mentioned an emergency-C and that's also probably another reason not to be on the Lovenox during labor; just another precautionary measure in case something calls for a C.

It's strange to even mention all the "what if's" but you never are the same after the loss of a baby. You know that things can go wrong and it makes you consider things you never thought you would. In a good way, you judge others less and realize that having a healthy baby is all that really matters in the end. I went from only believing in home births to now planning just in case I have to have an emergency-C! Life is funny.................

 

[5thAttempt]

Caroline,

you are so close! I wish you an easy labor!

I actually was induced last time (because my labor did not pregressed). It was very painfull, right after induction I asked for epidural but I was OK before induction. I was not on lovenox, it was a 'normal' pregnancy, so I did not have any concernes about bleeding etc. I appreciate you input. After reading your post I think that I am not getting enought care. I had my level 2 at 18 weeks (I wanted to have it ealier than 20 week to have enought time for amnio in case I needed it). Peri said that I do not have to see him again unless something comes up. I do not think my regular OB is planning to do scans every 4 weeks like you have. I undestand that you are getting them probably because of the blod clot with you previous baby. I guess since I did not had anything they think I do not need it? I am going to 24 week appointment in a couple of weeks and I will try to adress some issues. At the same time I am not sure what we need to monitor...Please keep me posted about lovenox after pregnancy - what is you decision.

 

[sarah9774]

I did not have any clotting with my son I lost, nor did he.. it was the fact that the clotting d/o caused the blood vessels to constrict and the pre-e that cut off his oxygen. I have had at least 9 US so far to check growth, and blood flow, and have them every three weeks now at 25 weeks, soon it will go to every two then every week until I have my c-section. I did not opt for VBAC due to the increased risk of PA. My Dr. did not recommend a VBAC due to the risk associated with clotting d/o's. I get my levels checked monthly right now and it will change to weekly as time goes on. No matter what, I will be anxious until this little boy is crying in my arms.. I really could care less how he gets here as long as he is alive.. I think the best way to get through this for me is to keep asking questions, even if people tell me it is ok.. keep asking questions...

 

[5thAttempt]

Sarah, thanks for your post, even if it made me even more anxious. Now I definitly will ask the question about why I am not having any more scans done. Actually I had a lot of them in my 1st trimester - pretty much every 2 weeks - since all my losses were during the 1st trimester. In the 2nd trimester I just had 12 week nuchal and 18 week level 2 scan. But they tell me that I do not need them anymore unless something comes up.

When are you plannig to stop lovenox before the c-section: 24 hours before? Also, are you going to continue it for 6 weeks after delivery? You are on lovenox, right? Also, if I can ask - do you have protein S deficiency?

 

[sarah9774]

I forgot to add that I asked for some of the US's because I needed to be reassured early on. I am on heparin 2 x's a day because the Lovenox was too expensive. I think that they will be taking me off of it 24 hours in advance. I will find out next appointment. Yes, I will take the shots 6 weeks post delivery. I do not have Protien S Def. I have Prothrombin Factor II Mutation. I would say that every doctor does things a little differently. Don't be too anxious.. I am haveing US to check blood flow in the uterus and in the cord. My Dr.'s office is pretty high tech with the 4-d ultrasound machine.. it is a teaching facility called Eastern Virginia Medical School.. may be another reason I get so much done. If you feel like something is off can you just go to labor and delivery to be monitored if you want?

 

[armymomof2]

hey everyone....found this site by chance....knew a little on the subject and thought i'd share...

i have a long family history of blood clotting and have lost family members due to clots. my mother had severe problems with each of her three pregnancies, and almost lost herself and us kids all three times. she has also had a couple of clots and is now on a blood thinner called coumadin for the rest of her life. so by the time i got pregnant we knew that there were some things that needed looking into.
after they took what felt like ALL of my blood, they came up with the answer. Prothrombin mutation, or blood clotting disorder. they thought it might also be protien s or c def., but as someone metioned before, those are hard to judge during pregnancy, and are best checked for 6 weeks after.

For my first pregnacy i was put on Heparin, 2xs a day in the belly.

i was taken off the heparin 3 days before the day i was to be induced. the inducing was planned from the beginning so that there were sure to be no problems or suprises. this also helps if you want the epidural. although the anesthesiologist will most likely do a blood check to test your levels and make sure things are safe before giving the Epi. things went just as planned, and everything worked out wonderfully. i continued to take the heparin twice daily for 6 weeks pp, as instructed by my doctor, hematologist, and my maternal fetal medicine specialist.

for my second pregnacy we followed everything from the first only this time we discoverd lovenox and i was put on that until 3 weeks before my due date when i was switched back to heparin, simply because it is easier to get out of the system quickly should the need arise. however again, i had a set day to be induced. the heparin was stopped (one day in advance) and the delivary went well. All except for the part where the anesthesiologist refused to give me the Epi. because he was afraid of the complications due to my blood disorders, and despite the fact that i had recieved a previous Epi. with no complications (let's just say he wasn't my favorite person that day!) but other than that "little" extra pain, everything went well.
after the pregnancy i was agian put on the lovenox for 6 weeks after.

-some advantages of lovenox: -only once a day
-and already set up for you, just open
and stick.

-but it's also WAY more expensive and both heparin and lovenox should be injected into the belly fat for the best and most effective absorbtion.

-during both pregnancies i was also told to take a low dose asprin (st joes) once a day, and wear compression stockings anytime i went on a long car trip (over an hour) and i also wore them in the hospital...even during delivery.

-i also had US's frequently (once a month) throughout the pregnancies to check for growth and make sure no clots had reached the placenta.
and halfway through the 8th month i went in for weekly NST's (non stress test) to make sure the babies were doing fine and were not stressed.

-clotting disorders and pregancies do NOT go well together, mostly because your blood thickens so much anyway during pregnancy, and levels do not return to normal until 6 weeks after birth. so ALL precautions should be taken!

-some other things to keep in mind if you have a clotting disorder:
-pregnancy is not the only time you are at risk.
-you should have a permanent hematologist in case of any problems.
-surgeries and bed rest are also risky areas.
-long car or plane trips are no good
-birth control pills should be a no no (they are known to cause clots, and if you already have a problem you don't need extra things going against you)
-and the best way to beat a clots is to stop them before they start!

i'm sorry this was such a long read, but hopefully it was helpful!

good luck to everyone!!!

 

[Nmoran]

Quote:

Originally Posted by armymomof2 hey everyone....found this site by chance....knew a little on the subject and thought i'd share... i have a long family history of blood clotting and have lost family members due to clots. my mother had severe problems with each of her three pregnancies, and almost lost herself and us kids all three times. she has also had a couple of clots and is now on a blood thinner called coumadin for the rest of her life. so by the time i got pregnant we knew that there were some things that needed looking into. after they took what felt like ALL of my blood, they came up with the answer. Prothrombin mutation, or blood clotting disorder. they thought it might also be protien s or c def., but as someone metioned before, those are hard to judge during pregnancy, and are best checked for 6 weeks after. For my first pregnacy i was put on Heparin, 2xs a day in the belly. i was taken off the heparin 3 days before the day i was to be induced. the inducing was planned from the beginning so that there were sure to be no problems or suprises. this also helps if you want the epidural. although the anesthesiologist will most likely do a blood check to test your levels and make sure things are safe before giving the Epi. things went just as planned, and everything worked out wonderfully. i continued to take the heparin twice daily for 6 weeks pp, as instructed by my doctor, hematologist, and my maternal fetal medicine specialist. for my second pregnacy we followed everything from the first only this time we discoverd lovenox and i was put on that until 3 weeks before my due date when i was switched back to heparin, simply because it is easier to get out of the system quickly should the need arise. however again, i had a set day to be induced. the heparin was stopped (one day in advance) and the delivary went well. All except for the part where the anesthesiologist refused to give me the Epi. because he was afraid of the complications due to my blood disorders, and despite the fact that i had recieved a previous Epi. with no complications (let's just say he wasn't my favorite person that day!) but other than that "little" extra pain, everything went well. after the pregnancy i was agian put on the lovenox for 6 weeks after. -some advantages of lovenox: -only once a day -and already set up for you, just open and stick. -but it's also WAY more expensive and both heparin and lovenox should be injected into the belly fat for the best and most effective absorbtion. -during both pregnancies i was also told to take a low dose asprin (st joes) once a day, and wear compression stockings anytime i went on a long car trip (over an hour) and i also wore them in the hospital...even during delivery. -i also had US's frequently (once a month) throughout the pregnancies to check for growth and make sure no clots had reached the placenta. and halfway through the 8th month i went in for weekly NST's (non stress test) to make sure the babies were doing fine and were not stressed. -clotting disorders and pregancies do NOT go well together, mostly because your blood thickens so much anyway during pregnancy, and levels do not return to normal until 6 weeks after birth. so ALL precautions should be taken! -some other things to keep in mind if you have a clotting disorder: -pregnancy is not the only time you are at risk. -you should have a permanent hematologist in case of any problems. -surgeries and bed rest are also risky areas. -long car or plane trips are no good -birth control pills should be a no no (they are known to cause clots, and if you already have a problem you don't need extra things going against you) -and the best way to beat a clots is to stop them before they start! i'm sorry this was such a long read, but hopefully it was helpful! good luck to everyone!!!

Hello!

This is my second child, first with the lovenox (theraputic) as I threw a PE my first 4 weeks of pregnancy. I am 3 weeks from DD and want to know when they "Induced" you were you at 38- 39 weeks? My ob, peri, amd hemo all have different opinions about delivery...stop lovenox, switch to heparin, induce, don't. You are the first I've read with great success and was just looking for more details!

Thank you!

Nichelle

 

[armymomof2]

hey nichelle....

my first pregnancy i was induced at 39 weeks, and i was put on heparin about 3 days before the delivery, and put back on it right after ( for 6 weeks) everything there went well, and i never had a problem.

with the second i was again set to be induced at 39 weeks, but was switched to heparin 3 weeks prior to (because the heparin is easier to get out of the body in case of complications, and my doctors thought this was best.), and was going to stop taking the heparin 2 days before inducing. however i was only on the heparin about 4 days when i went into premature labor. luckily i was on the heparin, because like i said....it leaves the system much quicker than lovenox....so by the time i was set to deliver, the blood thinners were completely out if my body (takes about 12 hours). again everything went fine...i was put back on lovenox right after the delivary ( again for 6 weeks).

it seems like switching to heparin a few weeks prior to and then taken off both right before the inducing is the best way to go...my mother also threw PE's and this system worked well for her as well....(they didn't have lovenox back then so heparin was her only choice)

i hope all goes well for you and your little one....hopefully your docs figure out what they want to do.....if you have anymore questions, just let me know....take care....

~colleen~

 

[Nmoran]

Thanks Colleen for the insight. I'm aware of all the benefits and risks with both therepies. My hemo doesn't want me to take the hep at 36 weeks because he does not want me to go sub-theraputic at all. My thoughts are, well if I go early and just took my lovenox and we run into complications then what do we do? I know you can take protamine, but that has risks itself! Problem is this is my econd incident with DVT/PE and I have done the gammit of tests but as of yet am considered "undiagnosed"...

Thanks again for your insight!

Nichelle

 

[5thAttempt]

armymomof2, did you ever had a blood clot yourself?

Also, I am on aspirin too, and OB said I have to stop it at 36 w since it takes up to 3 w to get it out of the system. Is it what you did too?

I just came back from my OB (I am 28w) and we talked about all possible solutions. My problem is that I have 4 dr in a group and a peri and they all have different opinions. Today OB told me everything I can do and I have to give him my decision. He said that since I did not had any clots before he would suggest me to go with #1, however he said that he undestand that my shots are my 'security blanket' - I had 5 m/c in the past and he is not going to push me one way or the other. Here are my possibilities and he said I can pick any one of them, he si OK with any one:
1) stop lovenox at 38 weeks completly and let the nature take its course. He said that only 5% woman go into labot before 38 w
2) switch to heparin at 38 w and wait till labor starts
3) switch to heparin at 38 w and stop it 2 days before scheduled induction
4) stay on lovenox and stop it 2 days before scheduled induction

I am leaning to #3 at the moment - any advise?

Nichelle, if you just took lovenox and went into labor - they will not give you epidural. If you need emergency c-section, it will be general anastesia. I had the same question to my OB and that was his answer. Hovewer, he said same applies to heparin, if you just made a shot and it is not 12 hrs after yet.

Also, about the induction date - he said that it could be 1w to few days before the due date. However he told me that if my cervix is ready (whatever that means) they can schedule induction earlier then 39w. They will start doing internal exams at 36 w and they can determine the state of my cervix then.

One other problem I still have is that he does not think that I need to do any shots after delivery. I am not sure I am OK with that. It is not taht I want to continue them all my life, but this is something many people do here. THe problem is that we all have a little different disorders and different medical histories.

 

[armymomof2]

hey 5thattempt,

no luckily i have never had a clot myself...we've always known what to watch for and have taken the necessary precautions.....

and as far as my advice on your choices....3 sounds best to me...i say this only because it was what i did...and both times worked well for me...i also had the kiddos in different states...so this was the method that each different set of doctors agreed on....it also just seems to make the most sense...this way your on the blood thinner for the longest time possible, and then still in control of the situation, by being induced.... and as far as the cervex thing goes, if your cervix feels ready early then they can induce you earlier...like with my second little guy...i was starting to contract and my cervix was 50 % efaced, and i was dialated 3 cm, at 37 weeks, so they decided to stop the blood thinners, admit me, and let me progress over night....but by the next day i hadn't changed at all, however since i was there, and things were showing signs of early labor, and i hadn't had a shot in about 24 hours, they decided to induce me then, instead of sending me home and chancing me getting back on the thinners only to go into natural labor....

the more you can control in these situations, the better....that's why i think inducing is the way to go....and heparin....b/c of how quickly it leaves the system.

but alot is going to depend on how things are when your closer to d.d...

and about the no shots after delivary....i would disagree....you are still at a very high risk of clotting up to 6 weeks after, ecspecially if you have a clotting disorder....so staying on the shots is the best idea...and after the baby...you'll have so much lose skin....you'll barely feel those suckers...

so anyway...i hope this helps....it sounds like you've got alot of cooks in the kitchen...and they need to make up their minds....so hopefully they will soon...if you need anything else...just let me know.... good luck!

 

[armymomof2]

hey nichelle,

i know its gotta be scary even thinking about coming off the blood thinners, ecspecailly since you've had problems in the past....i guess you can only listen to your docs and hope they know whats best....

and about the testing...have they only ever tested you while you were preganant or right after?? because, pregancy can throw off the tests...they had to wait 6 weeks after i had my first baby to test me and get the right results...and finally know what exactly i have.....

anyway...again hope things go well......let me know if there's anything else i can do.....

~colleen~