Anybody had to inject heparin during pregnancy (esp as a result of a previous dvt) - what's it like?

[zipzap]

Just wondering really...

I had a dvt 2 weeks after ds2 was born and took warfarin for 9 months (lots of problems keeping INR up!). A scary time and not a lot of relevant info available; everything seemed to be aimed at telling you about getting your dvt diagnosed after a pain in your leg flying .

I've been told that if I ever want another baby then I will probably have to inject heparin daily.

I would love to try again (and I'm getting on a bit so time is running out for trying let alone having!) but I keep wondering all sorts about the dvt

1. will it be painful injecting every day? after 10 days of jabs the bruises were getting bigger and bigger and there was less available space to do more - so what is it like doing it for several months?
   
   
2. When I had heparin injections initially and when my INR had dropped they were done at the hospital, during pregnancy they expect you to do them yourself - is it difficult, do you worry about doing it wrong or injecting air or injecting into pregnant stomach etc?
   
   
3. worrying about the risk of getting another dvt and having big problems or worse (dying) from it - very scary (and something that they were never able to say very much about first time around, despite all the dvt scare stories that you hear on the news, couldn't or wouldn't say what that risk was. Or would be should I get pregnant again
   
   
4. does heparin really really not harm the baby or have any other long term consequences?
   
   
5. what is birth like if you are using heparin - are there risks of excessive bleeding or going into sponteous labour or not being able to have epidural/c-section/etc?
   
   
6. any other worries or issues that you encountered that I haven't thought of!
   
   Anyhow, any thoughts or experiences would be really gratefully appreciated as I just don't know what to do and I really don#t want to end up making a fatal mistake - I know I would love another dc but not if it means a really high risk pregnancy! [scaredy cat emoticon!]

[zipzap]

anyone?

[thumbwitch]

"1) will it be painful injecting every day? after 10 days of jabs the bruises were getting bigger and bigger and there was less available space to do more - so what is it like doing it for several months?"

A bloody nuisance. I was getting DH to do it in my thighs and after 24 weeks of it I wondered if the bruises would ever truly disappear (they did but it took a while). Better in the belly, apparently.

"2) When I had heparin injections initially and when my INR had dropped they were done at the hospital, during pregnancy they expect you to do them yourself - is it difficult, do you worry about doing it wrong or injecting air or injecting into pregnant stomach etc?"

Couldn't bear the thought of doing it myself - DH had to do it. In thighs as prev mentioned cos of my concerns about injecting into massively tight belly. Air not an issue.

"3) worrying about the risk of getting another dvt and having big problems or worse (dying) from it - very scary (and something that they were never able to say very much about first time around, despite all the dvt scare stories that you hear on the news, couldn't or wouldn't say what that risk was. Or would be should I get pregnant again"

Can't answer that one as have never had DVT - have Factor V Leiden, hence need for heparin.

"4) does heparin really really not harm the baby or have any other long term consequences?"

Really doesn't harm the baby - cannot cross the placenta. No obvious longterm consequences so long as you don't damage yourself physically giving the injections - it doesn't last long enough, which is why daily injections are needed.

"5) what is birth like if you are using heparin - are there risks of excessive bleeding or going into sponteous labour or not being able to have epidural/c-section/etc?"

Heparin management will be discussed with consultant obst and consultant haematologist. Iirc, you must stay on the heparin until you are in actual labour, not the initial contractions, just in case. THen of course you stop for the birth but have to start again afterwards, while also taking warfarin, until your first INR result to ensure that your clotting is at the right level. Again, iirc, there were no issues with epidural etc., but then I hadn't had a DVT so it might be different for you. But you should be under consultant care, both haematology and obstetric, to make sure your needs are covered properly.

"6) any other worries or issues that you encountered that I haven't thought of!"

Breastfeeding - I was concerned about the warfarin but they assured me it was ok.
PLus I was taking daily fishoil supplements, which have an anticoagulant effect, but my consultant haematologist knew of no problem with me doing that as well as having daily heparin.

HTH!

[MrsBadger]

man that's long, hang on...

I am Factor V Leiden het (so not as serious as thumbwitch) and have never had a DVT, so just have heparin 6wks postnatally every time. If you search for previous posts I've made containing 'heparin' you should get a few useful threads.

1. will it be painful injecting every day?
   you get better at it - there are some injecting techniques that hurt less than others. I used to work down the side of one thigh, up the other side, across my stomach and then down and up the other thigh, so the original bruise had usually healed by the time that spot came round again.
   
   
2. Is it difficult, do you worry about doing it wrong?
   Again, it's practice - it's very hard to do wrong as the syringes are pre-filled, and if you do inject air it doesn't matter as they're subcutaneous (ie under the skin), not into a vein.
   
   
3. should I get pregnant again?
   Yes if you want to. With proper management you are not at major risk of DVT or anything else.
   
   
4. does heparin really really not harm the baby or have any other long term consequences?
   No, it really doesn't.
   
   
5. what is birth like if you are using heparin?
   This I don't know but your obstetric and haem team will - quiz them extensively well in advance as to how your labour is likely to be managed (ie would you be able to use the pool if you wanted to, will you have to have continuous monitoring etc)
   
   
6. any other worries or issues that you encountered that I haven't thought of!
   Much, much better to have heparin and be a bit bruised and splotchy for a year than either to have a DVT or to not have another baby and spend the rest of your life regretting it.
   
   People with much higher/worse risk factors than you will be in your 'high risk' cohort - all of you will get excellent care and should have safe healthy pregnancies and babies

[jerryterry]

Hi Zipzap,

I gave birth 7 weeks ago and had to inject Heparin throughout my pregnancy and for 6 weeks postnatally. I have Leiden Factor 5 and had spontaneous DVT in my arm about 4 years ago, hence when I became pregnant I had to take the Hep daily.

The injections sting but i got used to them and the bruises weren't too bad - but this is different for everyone. I just did them into my muffin tops when my belly got too stretched. I was also worried about injecting air, but was told that this is not possible.

The birth was pretty straightforward, there were some complications but these were due to being Strep B +. In fact, the only extra precaution I had to take during labour was wear those hideous stockings. I was supposed to wear them throughout the pregnancy but couldn't bear them when it was too hot. Apparently you may not be able to have an epidural if you take your Heparin too close to delivery (something about the spinal fluid?), but I didn't have an epi anyway so this didn't bother me.

One good thing about all this for me, was that my specialist haematology midwifes were really fab - at St Mary's, Manchester.

At my post natal review, the haemo consultant said if I want more babies to contact them before I fall pregnant so they can start me on the Hep prior to the pregnancy. So I would say see your GP if you are planning on getting preggers. Obviously not all pregnancies are planned, like mine, but it is best to start Heparin as soon as possible in the pregnancy.

This is just my personal experience though, so might be different for you. sorry, that's a really long post !

[wuglet]

Hi

I am on lifelong warfarin having had a previous PE so was on fragmin from starting to TTC until post delivery for both of my last pregnancies (so approx 1 year for first preg (as had to stay on fragmin for 6/52 post delivery as well) and 10 months for last one.)

1. will it be painful injecting every day?
   My advice - do it in your stomach for as long as possible.
   Once that is too stretched to be able to pinch an inch I alternated upper buttocks and thighs (because I found legs soooooo painful)
   
   
2. during pregnancy they expect you to do them yourself
   yes. not a problem for me as used to injecting. you don't have to aim for anything so it's just gearing up to do the stab that is the issue. Some people find it helps to rest the needle where you will be injecting it for a bit beforehand to "deaden the nerves" there...never worked for me though!
   There is NO WAY you will hit the baby!
   
   
3. worrying about the risk of getting another dvt and having big problems or worse
   
   DVT in preg is fairly common - presume you don't have any underlying condition. DVT in themselves not that serious - worst they can ccause in themselves is longterm changes in the lower leg - it is when they move that you have a problem. If you are on fragmin then should not really be an issue at all.
   
   
4. does heparin really really not harm the baby or have any other long term consequences?
   
   No it is too big to cross the placenta
   
   
5. what is birth like if you are using heparin - are there risks of excessive bleeding or going into sponteous labour or not being able to have epidural/c-section/etc?
   I had spinal and C section both times.
   Had been quite ill the first time and been on IV heparin for 24hrs before delivery.
   Second time stopped the day beforehand - but was told by an anaesthetist that he would be happy to do an epidural even if I had had an injection that day when I was considering VBAC.
   
   
6. any other worries or issues that you encountered that I haven't thought of!
   
   Think I have put enough up there! Will you just be on the low dose (2500) - I was on the full dose throughout (15000) which is a more painful injection - although not so painful I was prepared to do half dose twice daily which is what they suggested!
   It was suggested to me both times that I could stay on warfarin until I had a positive preg test then switch - presume you aren't on it any more though. (I didn't because I was taking aspirin as well and they don't go well together!)
   
   Phew my longest post ever I think!
   Hope it makes sense

[Gumbo]

I had to do this for 3 pregnancies. It's not so bad, honestly - you get used to it.

1. will it be painful injecting every day?
   I had to do it twice each day, so yes, it was an issue. But I was quite concise/strict about where I did it, and changed the place slightly each time until there was nowhere left, then I'd move to the other leg to give the 1st one a chance to recover. And sometimes - just for a bit of variety - I'd inject in the belly.
   
   
2. ...is it difficult, do you worry about doing it wrong or injecting air or injecting into pregnant stomach etc?
   Not difficult, the 1st one is the hardest. And they're idiot-proof ie. you can't really get it too wrong.
   
   
3. worrying about the risk of getting another dvt...
   If you're prone to DVTs then you have this risk anyway - as long as you're disciplined with your injections then I don't think your risk during pregnancy is much higher.
   
   
4. does heparin really really not harm the baby or have any other long term consequences?
   No, it doesn't cross the placenta. And if you land up having to stay on it a bit after the delivery, it doens't pass into breast milk either. However, they won't 'let' you stay on it for very long term because it causes issues with bone density and can contribute to osteoposis (for you, not the baby).
   
   
5. what is birth like if you are using heparin - are there risks of excessive bleeding or going into sponteous labour or not being able to have epidural/c-section/etc?
   I'm interested that one of the other posters had a spinal with it - I had to meet with the anaesthetist beforehand, and was told they absolutely wouldn't be prepared to touch my back until I'd been free from heparin for 24 hours, so I knew I couldn't have an epidural - and it also meant that if I'd required a CS it would have been under GA.
   
   
6. any other worries or issues that you encountered that I haven't thought of!
   Nah - it's a doddle!

[yomellamoHelly]

Am factor leiden V and prothrombin deficient. Had dvt during 1st pg and another 18 months after. Have 3 kids now.

1. Yes the jabs are painful. At 20 weeks the dose was upped to twice a day. Definitely a time to grit your teeth. Used to alternate legs but they were still covered in bruises. Couldn't face doing it in my bump. Not much spare skin towards the end either.
   
2. I found the jabs simple to do (if you discount the pain! - at least you could do them nice and slowly iyswim). They're pre-prepared. When I was on non-pre-prepared ones they gave me lots of training until I was happy. Did also go to gps on one occassion when just couldn't face the pain of doing it.
   
3. It's one of those gambles isn't it. Initially I was told I shouldn't have any more children and was devestated. I did look after myself though. Had stockings and was regularly in the gym or swimming or doing something active every day.
   
4. Can't answer this but don't believe so. Ds2 has sn, but I think it's one of those things rather than the drugs.
   
5. You need to stop taking it as soon as you think you're in labour. Was told I couldn't have an epidural and a csection would be GA if required but that was okay for me (quick easy births). Opinion divided as to how soon after birth I should then start again (caused some hassle with conflicting advice 3rd time).
   
6. I wasn't allowed an un-managed 3rd stage because of the risk of haemmhoragging. FWIW had small pph 2nd and 3rd time. Didn't require further treatment.
   Each time had to give birth on consultant-led unit "just in case". Nice big rooms but a bit OTT.

[zipzap]

thanks everyone for all your detailed answers; sorry, I hadn't meant to post such a long OP with so many questions !

Looks like it can be painful but it can be worth it... I just had the one dvt after having ds2, I wasn't ever tested to see if there was an underlying cause ('pregnancy' I was told - not that they bothered to double check it could have been anything else).

I guess I need to go have a long chat with the doctor and see what she has to say and see if I need to take heparin straight away or just if I get lucky and conceive.

Unfortunately where I live the local maternity unit had the misfortune of being voted the worst in the country while I was pg with ds2 and after my experience with the consultant whilst I was having contractions (he didn't notice I was in labour, tried to send me home despite MW joking about I really should be getting over to the delivery unit, baby turned up less than 30 mins later) I can understand why, so I might have to be quite pro-active at managing this myself (with a little help from mumsnet of course) but it is definitely not a 'don't do it' from you all which is great to hear - thanks again for all your advice!

[thumbwitch]

zipzap, with your history of having a DVT, you could push for the test for thrombophilia - there are different types, Factor V Leiden is just one of them. It is worth knowing whether or not you have it in terms of future health risk post-operations, on long flights etc. There isn't any treatment except in high risk conditions such as pg, post-op. But more importantly, if you know you have it, you can at some later stage get your DC checked to see if they have it too.

We only found out because my uncle died suddenly of a PE - his family were told to get checked and they told my Dad (his brother) - he had F V Leiden, so we 3 children were also checked - both me and my sister have it too (but not my bro) so when our DC are older, they will all be tested as well. Factor V Leiden is fairly common - 1 in 20 people have it.

The test doesn't cost you anything, the GP should do it for you.

Sorry to hear about your shocking maternity unit - things like that would make me wonder about moving to a different area!

[zipzap]

thanks thumbwitch for that - I'll ask the gp next time I'm in and see if I can get it done. Must admit, I do wonder as on occasions I do get sore legs.

But then I think I am maybe being too paranoid - mostly because my DVT was discovered by chance - they were scanning my leg because of phlebitis not going in a different part of my leg and they did the whole leg rather than just the bit with phlebitis on and there it was. None of the usual telltale symptoms that you read about - no real swelling, redness, heat, pain etc. My leg was just a bit sore and the phlebitis in a different bit of it.

I have been back to get my leg and groin scanned once when it got really sore in a similar way to how it had been but I was made to feel really uncomfortable and like I was wasting resources and peoples time when I went to the vein scanning place at the hospital (although the GP didn't really mind and was 'better safe than sorry'). On the one hand they say that you will get pain as a result of having had the dvt but that you need to keep an eye out for same thing happening.

In fact, I'm sitting here now wondering about whether or not to go and get them looked at again as they have been sore the last few days and I have been sitting more than usual but then I think that I don't want to 'cry wolf' too many times and not be able to get them sorted if they do get really bad IYSWIM. Wish there was an easy way to tell at home!

As for the maternity unit - I was lucky in so far as we saved up and instead of holidays used the money towards a private midwife, a couple of other factors contributing towards why dh and I thought it would be a good idea. But she was fantastic and made so much of a difference, meant I was able to leave hospital 4 hrs after ds2 was born yet I knew that somebody would be with me in minutes if there was a problem and we are only 5 mins drive from hospital. So would definitely save up and go that route again if I am ever lucky enough to have another baby! Also meant that, although she wasn't supposed to do 'mid-wifing' in the hospital, she is just supposed to be like a doula, she can do something in an emergency. And they were so short staffed that she'd got gloves on and was helping me out (she does a bit of locum work up at the hospital to keep in touch there and she also had trained the mw that came in for me) which was nice. sorry, I digress! But other than that we are in a fab place, perfect for being close to family, access to work, nice house, etc etc so don't really want to move. and I figure that I am not going to use the maternity services that much more; not like something that I need to do use every week or month!!