Blood clot in arm - 30 weeks pregnant!

[amz1985]

Within a week of finding out i was pregnant i was diagnosed with a blood clot in my right arm - apparently i have an inherited gene (Factor V Leiden) which coupled with my pregnancy may have caused the clot. I was put onto clexane straight away and have remained on the needles ever since. I would just like any advice from someone who also suffered a clot during pregnancy as i have had NO information regarding the actual birth. Will the fact I already had a clot mean i will have to have a planned birth? If anyone has suffered a similar problem to me and gone on to give birth PLEASE share with me what happened and how long after i will be on these dammned needles for!!!

Thank you
x~x~x

[3littlefrogs]

Usually an induction of labour is planned, and the clexane is either stopped or reduced 24 hours beforehand, depending on the advice of the haematologist(who will weigh up the risks of clotting versus risks of bleeding).

As you have a proven risk factor, your clexane will be restarted after delivery for about six weeks. Then, you will be referred back to the haematologist to discuss your future management options, in particular with regard to future pregnancies.

It is usual to actively manage the delivery of the placenta by giving an injection to make the uterus contract after the birth of the baby, to reduce the risk of bleeding.

HTH

[3littlefrogs]

Sometimes, if the clot happens early in pregnancy, AND there is no proven additional risk factor, the clexane can be stopped earlier, but TBH, with factor V leiden, it is probably safer to carry on until at least six weeks after delivery.

Have you had a chance to discuss this with your consultant?

[3littlefrogs]

Have to go now, but will check back later.

[rubyslippers]

i have had various clotting issues in both my PGs

am currently PG after DVT early on so am injecting twice a day (bleurgh)

no planned induction for me with DS1 - went into labour naturally and gave birth ok (had some issues stitching because of trouble stopping the bleeding) but basically everything was fine

was on warfarin for 6 weeks post birth

with this PG i am planning a natural delivery - am high risk PG again but consultant has agreed to me using the birting unit as opposed ot the labour ward which i am very pleased about

epidural not recommended either because apparently anaesthesia is very closely related to blood clotting (3littlefrogs is v knowledgable and can probably put me right)

[3littlefrogs]

Hello (waves to rubyslippers - congrats on your pregnancy!)

Practice does differ between hospitals and between consultants IME. However, epidural can be a possibility, depending on local practice and on the anaesthetist. It is always a question of weighing up risks and benefits, and that has to be in consultation with the different consultants involved.

The reason practice varies is because the guidelines on "best practice" are still being worked out, based on very careful information gathering from years of experience.

The state of knowledge and expertise is infinitely better now than it was ten years ago, so please don't worry - I am sure all will be well.

[3littlefrogs]

Sorry - I didn't mean to be "putting you right" rubyslippers, just to say that it does depend on many factors.

[Gumbo]

I have Factor V Leiden and had to inject twice daily during my pregnancies, and for 3 months afterwards. With regards to the actual birth, the only real issue was that the aneasthetists refused to go near me with any sort of epidural or spinal block within 24 hours of my last injection... I knew this in advance so knew I couldn't have an epidural, but it also meant that is an emergency CS was required it would have had to be under GA.

(The good news is that I had a room full of 'relevant' people (haemotologists etc) on hand when things started to go a bit wrong during delivery - so you'll get the best care!)

[drinkmoretea]

Hi Amz, I too have Factor V Leiden, I suffered two DVTs a long time ago and was therefore on Warfarin. When I was planning to become pregnant I had to come off the Warfarin and inject myself with Fragmin (a type of Heparin, sounds similar to what you are taking) I had to inject myself throughout my pregnancy, it was never mentioned at any time that the birth had to be planned. And being pregnant with twins it could have happened at any time!!! Which it did, they were born early. I delivered the placenta naturally. After the birth I went back onto Warfarin and wore support stockings on both legs for a fortnight!! (nice)

In my experience you may probably be on Warfarin after pregnancy for a short time and monitored before coming off it. Normally you would only go back onto Warfarin after a second clot.

I hope that helps, if you have any questions though I will be happy to try and answer!

[drinkmoretea]

I forgot about the Epidural Gumbo! And was given the same info as you about CS...

[amz1985]

thank you everyone for replying!! I have had a number of hemo appointments however they seem to just concentrate on my arm and not the pregnancy - obv i have asked questions and the last time i went they said either planned labour or natural delivery.
It's really nice to know other women with the same condition have gone on to have a relatively normal labour - with a healthy baby at the end of it.

I'll just have to prepare myself for carrying on with these needles a few weeks after giving birth.

Thanks again everyone ! Really put my mind at rest xxxx

[PiNkY13]

I was 25 when I had a deep vein thrombosis followed by mulitiple pulmonary embolisms and was on warfarin for 6 months. I then found out I was 6 months pregnant, my DVT wasnt linked to pregnancy, I'd had a broken ankle and been immobile. For the remainder of my pregnancy I had to inject myself daily with clexane (heparin) and for 6 weeks post natal. I was told by one of the obstetricians registrars I would need to have a planned labour due to being on anticoagulants but nearer my due date I saw a senior obstetrician who said there was no need to have a planned delivery as the dose of clexane was a low preventative dose not a high dose. The only recommendation was that if I started to have contractions and they were the real thing I should skip my injection for that day and when I contacted the hospital I was to remind them I was on claxane due to history of blood clots. I started having contractions on the monday so missed my injection that day and also the tuesday. I gave birth on the wednesday and immediately after delivery I had to put on support stockings and 2 hours later I went back onto the injections. I wore the stockings and injected myself daily for 6 weeks.

With regard to further pregnancies I was told by my obstetrician that if i wanted more of a family I would be required to be on clexane/heparin injections again and therefore would recommend a planned pregnancy next time round and would like me to make an apppointment with him to discuss things first but it wasnt going to be the end of the world if I found myself unexpectedly pregnant.

I hope this is helpful to anyone finding themselves in a simillar situation I was in.

[PiNkY13]

May I also say I this told it would be the same for natural birth or C section. I had a natural birth and baby was healthy. As I was on warfarin for most of my pregnancy there were alot of possible birth defects but thankfully I gave birth to a very healthy baby. He had tests at regular intervals during his 1st year to make sure everything was fine and he was developing properly. He had x rays taken when he was 6 weeks old to check for warfarin embryopathy as he had a slightly flattened nose at birth. He got the all clear from those x rays and he still has a cute squashed nose but have since found out its the same nose my grandad had and my Auntie!!

[Lusi]

Hi
I have a history of DVTs and was diagnosed as having Anti-phospholipid syndrome (APLS/Hughes syndrome/Lupus anticoagulant) but now test negative...knew this before both of my pregnancies and have been treated as a high risk of clotting/still test positive.
I was on Fragmin/Heparin injections (twice daily) for both pregnancies and 75mg aspirin (daily).
Can't remember what happened with aspirin for first pregnancy - but for second stopped two weeks before (more likely to cause excessive bleeding than fragmin). Clexane is similar (a low molecular weight heparin) to Fragmin. Main problem would be if you needed an epidural (as Gumbo says)- excessive bleeding shouldn't be a problem.

For my first pregnancy I was to be induced 3 days before my due date - so that I could stop the injections 24 hrs before (although had two opinions on this - one consultant wanted me to stop 3 days before)...my waters broke the day before I was due to stop the injections...long story but DD1 was born naturally a minute before she was due to be induced!
For DD2 different consultant who doesn't like inducing and basically told me to stop the injections when I had any real sign of the start of labour - had the show on the Sat - stopped injections and DD2 born naturally on Mon pm (3 days before her due date).
Within hours of giving birth for both I started the injections again.
Did 2 injections a day for 6 weeks afterwards (told this is a very high risk time) with stockings on both legs night and day (very sweaty! but I had to wear a full length one in the day for 10 years on the leg damaged by a massive DVT -so I might be a special case!)
Also was still bleeding slightly at 6 week check up (day after I'd stopped the injections)- one GP said probably was due to fragmin but he got second opinion - who said an infection - funnily enough bleeding stopped that night - before I'd managed to pick up my antibiotics ...

If you will be on Wafarin full time it might be worth going on it after the birth...can take a while to get it adjusted though - so it might be safer to carry on with the injections at least for a few weeks (kind of thing a good haemotologist can advise you on).

Finally (and I have dithered whether to mention this but kind of think better to be safe than sorry) Are you having extra monitoring? In your situation I would talk to my consultant about extra growth scans - I know with APLS there is a risk of clots forming in the placenta which can seriously harm your unborn child - first sign of a problem is a slow down in growth. For DD1 I had weekly scans for the last 3 months - for DD2 (cos I'd already done it once) I had less but still had two in the last 6 weeks.

Take care and good luck...