Pregnant with a history of PE/DVT

[JBrd]

I had a pulmonary embolism in January and was on anticoagulants for only 3 months after that - since it was pretty obvious that it was the pill that caused it, my consultant thought it'll be safe to limit the course, while making sure I use alternative methods for contraception. My recovery has been going very well, I feel fit and healthy again and don't seem to have any after-effects of the PE.

I'm now 6 weeks pg with my second, and a bit at loss as to what to expect. Went to the GP, who's written a referral to the consultant haematologist, as I will have to take clexane during my pregnancy. However, I have heard nothing back yet and cannot get through to his office to chase things up! I should be starting the clexane during my first trimester, but with the Christmas break coming up, I'm getting anxious that this will happen. Nervous because we are flying to Germany for the holidays...

Anyone here who is pregnant with a similar history? What is happening with you regarding medication, consultant appointments, check-ups etc? I'd also be keen to hear about possibilities for birth options, am I looking at an elective cs for sure now?

I have had 2 PEs due to a blood disorder. During both my pregnancies I was on Fragmin injections and had regular blood tests and check ups with my haematologist. As soon as I found out I was expecting I had to start on the jabs.
When I was in labour I was told that I had to wait 12 hours after my my last jab before having an epidural, luckily I didn't need one! I wasn't allowed the water birth that I really wanted and I had to stay in over night so they could keep an eye on the bleeding. An elective cs was never even discussed with me, so I don't think that is your only option.
I hope this helps and sorry if it isn't worded well.

I had a PE and was Warfarinised for 6 months even though it was my pill that had caused it. I fell pregnant a month after finishing the anticoagulant therapy and started on Clexane straight away (converted to Tinzaparin due to supply problems). I had to go for monthly bloods in the Maternity Dept (pre and post Tinzaparin dose - handy as I was working nights down the corridor so they would take my blood, give me my Tinzaparin and tuck me up in bed for an hour until the next blood test was due (I once slept through the blood test!!))
I too was flying (at 12 weeks) and had to have an emergency supply of injections for on the flight - I kept them with me flying out (had a letter from the Dr) but the air hostess kept them safe on the return flight.
My birth plan was to stop the Tinzaparin 12 hours before going into labour (crystal ball time) and have my clotting corrected on admission. I knew that an epidural probably wouldn't be an option and that if I had needed a CS, I would have had to have a GA.
However - when I arrived at the delivery suite, I was already 6cm dilated and was only an hour from actually giving birth - simple, gas and air and a load of stitches but no problems with bleeding and no need to continue anti coagulation therapy.
Good luck with everything OP!

Thanks ladies, that is really reassuring!

Now all I have to do is get seen by the flippin' consultant haematologist, grrrrr. Still no luck with getting through...

What the others have said really :). I was in the consultant led delivery unit (as I guess we all were) and was offered the pool so don't completely rule it out.

I was scheduled for a 39 WK induction to manage dose during delivery, which some consultants do, others don't. LO had other ideas and came at 38 wks (not complaining!). I ended up with epidural as she got stuck; had to wait due to 12 hr rule but anaethetist was there with alternatives (not pethidine) and was great. I had better care/delivery than many friends so don't worry :)

Can you call your GP and get them to try and chase it up for you - you mustn't wait, unless you know you're not supposed to be starting treatment yet.

I'd think a short haul flight not very high risk, sorry, I don't know much about it.

All the best x

I had a PE during this pregnancy, have been on fragmin ever since and will be until 6 weeks after the birth. If I ever had another pregnancy i have been told I would start a preventative dose immediately. You could phone the heamotology dept and ask for an urgent message to be passed to the consultant - or tell your GP to do so. I'm shocked that you haven't been given the injections already & also that your GP is happy to leave you unprotected & even to let you fly.

I just saw that you' ve been trying to get through to the office, sorry. I would drive to the hospital and bang on his door if I had to! I had a scary time with my PE & the GP's took far too long to refer me for tests, even though I was gasping for breath constantly, so I am really wary now. Good luck.

I have now received a letter that I have an appointment with the consultant haematologist - for Jan 17. Which is the last week of my first trimester!

Since then, I have spent what seems a lifetime on the phone to everywhere and everyone to get my referral changed to 'urgent' and to bring forward the appointment, but no progress Rapidly losing hope it will happen before Christmas...

I have called:

The community midwife, who gave me a contact number for the midwives at the hospital.

The midwives at the hospital, who took all my details and history and said they would send/fax it all over to the consultant's office with the request for an urgent appointment.

My GP - left a message with the receptionist that my GP goes back and marks my referral as urgent. Apparently, he didn't do that, which is the cause of all my woes.

The haematologist's office - always get the answerphone, have left about 3 messages already.

The NHS appointment helpline - daily phone calls to check if they have had a cancellation, no luck so far.

I'm really struggling to focus on anything else at the moment, work are not getting their money's worth out of me at the moment...

What about contacting PALS? I haven't used them but have heard that they are helpful about taking over & getting results. I can understand why you are panicking. It's ridiculous that you haven't been seen.

Surely your GP should be chasing - can the GP prescribe a preventative dose of blood thinner until you see the consulant?

Festive - that's what I thought my GP would do when I saw him after I had my BFP! But was told that they don't write prescriptions for clexane, apparently, it has to come from the consultant. Hmph.

Incidentally, I finally managed to get through to the haematologist's office today - but of course there are no appointments before Christmas. Apparently, the thrombosis team/nurse did look at my case file and thinks I'm OK to wait until January... Hmph again.
I feel so tired and drained today (lots of other preg-related stuff happening) that I've decided that's it, I give up. I'm obviously not meant to see the consultant before Christmas, and everyone seems to think it's OK. I just don't have the energy anymore to keep chasing them. Fingers crossed all stays fine until January...

Hmmm, I would have thought you need to be anticoagulated now. If previous episode was due to pill it was oestrogen related which means you are higher risk for pregnsncy and rcog guidelines state that antenatal prophylaxis is indicated and referral to expert. Can midwives get you in to see obstetrician urgently? They should be able to address it.
Good luck with it all!

Due to a previous non pregnancy related dvt, I was on clexane throughout my 2 pregnancies. The first dose was prescribed by the ante natal consultant who then referred me to the blood consultant for regular monitoring.

I also saw the someone who explained pain relief options during labour (essentially no epidural) but otherwise everything was the same as anyone else but with more monitoring.

I've had a PE after having my dd2 this year. I've been advised thatvi need to start fragmin the moment i get a bfp in the future. I also have to inject if i fly within the next 12 months. So i'm quite shicked that you're being left to it. My haematologist has done a telephone appointment with me before. Could you perhaps request one instead of a formal appointment?

In terms of birth i have two friends who had dvt/PE and both were given elective c sections as their haematologists felt it was a more controlled situation in the event of a bleed.

Ignore my typos its 4am!

Hi I am 14wks pregnant and had a 9.5inch dvt due to c-section with my third child . I was put on 5000mls of fragmin as soon as my test came back positive, I had to chase appointment but now I am well looked after, specialist every 6wks and Gp every 4. I also wear support stockings as further precaution. you must push for appointment as until you're on the books of specialist you are just another number. good luck xx.

yes Ive been told Im going to be induced early for same reason

I also was under the impression that I needed to go back on the anticoagulants as soon as I get pregnant, but my GP dismissed it because the consultant letter from the PE said to start within the first 12 weeks. The thing is, my appointment is exactly when I'm 12 weeks - and we are flying to Germany for Christmas. Getting worried now, after all what you ladies have been saying... Might see if I can get an emergency appointment with the GP again next week - the problem is the only way to get a same day appointment is to use their stupid 'sit & wait' system. They tell you a time to turn up at, and then it can be anything from 5min to 2hrs waiting until you get seen.

I just don't understand why they are being so sloppy, when all of you were put on the anticoagulants immediately! Even more, my PE was most likely caused by the pill, so def a link to hormonal causes there. Plus, I'm 40. Plus, I'm (although a lot less than I used to be) slightly overweight... To me, that's textbook, but no one from the medical profession seems to agree. Or can't be arsed to push the system, which is more likely.

The most annoying thing is that I have private health insurance, but -of course- any pregnancy related issues are not covered

Please Jbrd do not take no for an answer. In your position and unmedicated I would be going to the out of hours over the weekend (ours is in the hospital and they are more likely to be able to get an on call haematologist to see you).

I had multiple bilateral pulmonary emboli in my last pregnancy and was an inpatient from 7months and had significant lung damage. I was on daily heparin whilst pg and immediately following the birth, post partum I was in warfarin for 12 months.

I did a lot of research and spoke at length to my consultant haematologist and decided my DD2 would be my last. The consultant said if I were to conceive I would need heparin immediately. The biggest risk factor for clotting is having had a previous clot so please kick off until you get somewhere.

My consultant said a pulmonary embolism whilst pregnant is a nine on his seriousness scale that was the phrase that scared me and is a significant cause of maternal and therefore foetal death.

Go tomorrow to the out of hours - do not leave until you have medication. Better to be a pestering arse than a very sad story.

My consultant also said when medicated I was safe as houses, scouts honour that I wouldn't clot again. So you will be safe under correct medical care.

Oh and congratulations on your pregnancy feel free to pm for a chat.

Hi all

Would like to know if there is anyone who can offer advise on pregnancy after P.E -Pulmonary embolism. I have a 6 year old who I had a health pregnancy with and a natural,uncomplicated labour. When my son was 7 months I had an p.e episode (clots in the lung) due to going back on my pill (the doctor believed). I was on blood thinners for 6 months and had no problems since. My copper coil is due out next month and am planning my final pregnancy however was not sure how my p.e would effect it. I have been to my GP for advice and felt nothing was answered. They have asked the Haematology clinic to email me with some pregnancy advise. Any advise would be appreciated.. I'm worried.. will I just put myself and possible my baby in danger ?