blood clot @ 27 weeks

[DrMouse]

Hi All,

Just wondering if anyone had anything similar?

I'm being treated with low mw heparin and have to get the leg with the clot re-scanned later in the week. Until now my pregnancy has been low risk and I was planning to give birth in the birthing centre - does anyone know if I will still be able to?

Sorry to hear that DrMouse.

I had a post-natal blood clot with DD1 and was on Clexane throughout my pregnancy with DD2. They still offered me the "home from home" unit within the hospital for the birth with DD2, but I don't know if I'd have been allowed to go to a separate birthing centre as I was on consultant-led care (although that might have been partly down to the fact that DD1 was premature, as well as my health problems).

I guess you can only ask!

Thanks Bramshott - seeing consultant on friday so will be able to ask all my questions then. It was all such a shock over the weekend that all the intelligent questions went out of my head!

Best to ask your MW - can't see why not. The heparin/clexane should keep you from making any further clots (you will be on it for the rest of your pg now, and any future ones) and the one in your leg should start to break down over the next few days. Could take a while to go completely though.

You will go under the consultant haematologist and obstetrician as a result of this - ask them what their action plan is for you and whether or not you will be ok in the birthing centre.

It might be advisable to get yourself checked for thrombophilia after you've given birth as well - one type, Factor V Leiden is pretty common (5% of the population) and is hereditary. Factor V Leiden is a mutation of the gene that produces Factor V - makes it resistant to the control processes involved in blood clotting and hence prediposes you to make clots, a risk that increases enormously (about 35x) in pg, and also you have a higher than average risk of DVT when flying. (I have this, did you guess?)

I had prophylactic clexane from week 16 of my pg so never made a clot - but had no real problems giving birth naturally apart from needing induction. Problems could have arisen if an emCS had been required because of the anticoagulants; but then my sister had an emCS and she was also on clexane (she has it too) so they can still do it, they just have to be more aware.

Oh I forgot to mention the reason why you should get yourself checked for thrombophilia - especially if you have a girl - is that it affects your choice of contraceptive pill as well. Can't have a combined, can only have a progesterone-only one.

I had a PE at 36 weeks in my first pregnancy, I was on high dose clexane until I gave birth in hospital but there is no MLU or birthing centre here anyway, then I had to take Warfrin(sp?) for 6 months.

Have had to take prophylactic doses of clexane from about 14 weeks in second and this pregnancy and have been classed as high risk in both susequent pregnancies.

I was refused a homebirth due to the fact I'm on clexane this time around which I didn't argue with but am arguing with the fact I have been refused use of the birth pool in the hospital.

don't blame you, notso - what on earth is their reason for refusing you the use of the birthing pool??

They will probably advise a consultant unit for the birth because any tratment to thin blood presents some risk of increased bleeding.

At our local hospital there is a midwife unit and a consultant unit. Is there anything like this at yours?

Thanks for the advice everyone

Planning to give birth at the Whittington in North London, where the birthing centre is on the floor below the labour ward but apparently all shiny and new.

The staff that I met on the antenatal ward over the weekend though were all lovely so I'm a bit less worried about having to give birth on the labour ward now.

DP has been injecting the heparin into my arm but he's not that good - I am really bruised all ready and I think it is even more traumatic for him!

oh hey, not the arm! Horrible place to do it. I had it in my thighs - more fat there - but it still bruised like buggery. Since then (and not being pg) whenever I do longdistance flying I have a heparin shot and it goes in my tummy. I couldn't quite stand the thought of that while I was pg but it is a lot less painful - more fat, fewer nerves and a lot less muscle. So if you have a little bit of love handle, get him to do it in your tummy instead.

Oh and it will bruise most of the time, tbh - even if they are just little bruises - because the clexane is stopping your blood from clotting to block the leakage of blood from capillaries. But it just hurts more where muscles are involved.

I used to do my injections on the sides of my waist, even with a bump there. Sometimes I even managed not to bruise ! The Clexane needles are pretty small though - if the OP is on Fragmin, I seem to remember that the needles are much bigger. I got DH to do the injections when I was on that straight after my clot.

OP - the main thing is that actually, this is a pretty common (if unpleasant) complication of pregnancy and birth and your hospital should be used to dealing with women with clotting issues.

Thanks for the tips - would be easier in the thigh or love handle as then I could do it myself.

Bramshott and thumbwitch did you find it better to keep the leg elevated or move around? also how long did you wear the super sexy stockings?

thumbwitch they said because I will bleed too much after birth, I did have a big bleed after DC2 but I am still as that for a reason.

I find if I pinch a good wadge of flab (unfortunately I have plenty!) and keep pinching hard throughout injecting then I don't bruise.
I do have to resist the urge to rub though as it stings but if you rub then a bruise is guaranteed.

Hmm, sexy stockings I wore throughout my PG with DD2, but those were different ones I think (only knee high, came in a variety of colours). I actually found them quite comfortable and just used to wear knee high boots under trousers. Took them off 6 weeks after birth. I think if you actually have a clot, the advice is to keep wearing the stockings for as long as possible to prevent ongoing damage to the veins. I wasn't told this, so I only have one of the white stockings (the same kind they give you if you have a c/s) and I didn't wear it for long .

I think you just do whatever keeps your leg most comfortable - no need to keep it elevated if it doesn't hurt too much. The anti-coagulant stuff you are on now will be doing the work of stabilising and dispersing the clot.

I had bi-lateral PEs in a pregnancy earlier this year which they think must have started with a DVT, but I'd had no symptoms of one. Even when I got the PE's and could barely breatrhe, certainly not walk anywhere, I was insisting to my DH that I was 'just pregnant with twins, I'm bound to be short of breath'. My sats were 80% when they checked.

Anyway, I was on a treatment dose of clexane for six months from the diagnosis of the PEs. I would have changed to warafrin after the birth, but we wanted to TTC again right away. I was told I wouldn't be able to have an epidural in labour, but my pregnancy was very high risk anyway, so birthing anywhere other than the hospital under consultant care wasn't an option.

I am now pregnant again and on one 60mg dose of clexane once daily. I haven't discussed birthing options yet, but I am considered very high risk, so hospital it will be. I am doing the injections in my tummy this time, as I still have bruises in my thighs from the last lot of injections. It hurts more in my tummy, but I bruise far less.

DrM - I never had a clot so didn't need the stockings until I was giving birth and afterwards. I kept them on throughout my 4 day hospital stay and wore them for a good week after going home, until my INR (measure of warfarin anti-coagulation) stabilised.

That is a good point re. the low mw heparin - are you on clexane or fragmin? I would think clexane, even though you have a clot - but could be wrong.

oops, missed the bit about the stockings.

I hated them. They have suggested I need to wear them throughout this pregancy and if I do I am going to ask for a few pairs and try and dye them. I had to keep mine on for six weeks post birth, apparently this is one of the highest risk times for clots.

Poor you Midori sounds like you had an awful time!

Thumbwitch- drug is called Innohep (Tinzaparin Sodium)