Heparin when pregnant with twins & over 40

[Hobbes39]

Hi - I'm nearly 22 weeks preg with twins and I'm 42 so I'm classed as being a high risk pregnancy. (I'm otherwise relatively healthy though!)
At our 20w appointment the consultant said to me to think about whether I wanted to take heparin (injections) as I tick 2 of the boxes for increased risk of DVT (older & multiples). She recommended that I do take it post delivery (as that's supposedly the highest risk time) but left it up to us to decide whether to start taking it at 28w as this is something they have just recently started to suggest for 'high risk' pregnancies. I have had a look over the info and to be honest, while I'm usually someone who will err on the side of caution, I'm not keen to inject myself every day for possibly 9/10 weeks before babies arrive and then a further 6 weeks afterwards. As post birth is the highest risk time, I feel I would be silly not to do it for a couple of weeks post delivery... but before and after I'm not keen. I am being stupid? Should I just do it and avoid the risk? What have others done and why?
I should explain two things - one I have a DS who is 5 and had no issues with clotting or anything with him (no family history either) and secondly these babies are the result of many rounds of IVF and so I'm sick of injections and would really like to just try enjoy this pregnancy, not dose myself up with more drugs. I realise that having had IVF may increase my risk level though (however I can't see that anywhere in the info).
Any thoughts?
Thanks!

Unlike Aspirin low molecular weight Heparin doesn’t harm either you or the baby at the doses the consultant would be recommended. At 42 the miscarriage rate is 50% and the stillbirth rate associated (with and without spontaneous clots) is fairly high especially with twins - based on that I’d probably take it.

@Teddybear45 - thanks for your reply. when you say miscarriage rate is 50% - I'm already 22 weeks along - surely it's not that high still?? Where are your stats from? Thanks

Teddy Aspirin is not harmful. Neither is the risk of miscarriage 50%. The OP is 23 weeks FGS!
OP I would take it, it's not going to hurt and could help

The stats are based on a large Danish study where 50% of pregnancies in women aged 42 ended in a loss (this is probably cumulative across 4-24 weeks). After 24 weeks it’s classed as Stillbirth and the risk for older women is higher for that too hence why some trusts insist on inductions before 39 weeks if you’re over 40 and why many insist on heparin even in later stages of pregnancy.

This is all stuff your IVF consultant should have gone through with you. Mine picked through the various statistics to make it relevant for my age (I’m almost 40)— but far too many clinics use the lower numbers for younger women and are basically lying to older women.

www.ncbi.nlm.nih.gov/pmc/articles/PMC27416/

Our IVF clinic has pretty much everyone on injectable blood thinners throughout pregnancy. It improves statistics for miscarriage and presumably stillbirth. If they're offering it I'd take it?

I think I’d take it Hobbes. It’s only a short term thing and if it gets you all home safely it’ll be worth it.

I’ve been stuck on Aspirin and told likely induction at 39 weeks.

I was prescribed heparin from very early pregnancy (not ivf) after an unexplained Mc in a previous pregnancy at 15 weeks. My risk factors were the Mc and family history of thrombophilia (clots). I wasn't thrilled to be taking it but I felt the possible alternative was worse. My baby is now 19 months and healthy and happy. I think if I were you I'd take the heparin as the possible repercussions of not taking it are serious. Though I do think this is scaremongering from the doctor?

My dh has said that in any future pregnancy there's probably no need to take heparin but having lost a baby already I wouldn't take the risk.

Which is funny because I never take any other medication - no painkillers or anything. But I took heparin for 10 months.

I think my reply rambled on a bit so apologies for that!

I took aspirin as prescribed too up until 36(?) weeks

Read through that study Hobbes. It’s mostly about spontaneous abortion risk which I’m pretty sure that everyone from the over 40 page is well aware of.

Once you get past viable stage (very soon for you) then the risk is only slightly higher and ironically equivalent to that of teenage pregnancies.

@NaughtyLittlePassport - thanks.
@Teddybear45 - I know my miscarriage rate was high early on - I was oh so very aware of this, but I also know that after the stage the placenta took over and the babies were still fine that that risk dropped significantly. I realise that I'm still higher risk that someone younger, but we are talking a range that is now below 1% as far as I have been told.
That aside, I am on aspirin and have been since 12w as a precaution against high BP due to twins (my BP is currently low though, not high!). I'm happy to continue aspirin as long as required.
I think you are probably right @Karigan195 - I have got this far so should probably take it, but just questioning it as I've so far not seen any study that shows that risks of stillbirth are reduced when taken by someone with no history of thrombosis...? I think I will take it regardless for the weeks after delivery as my consultant told me that that is highly recommended but the fact that she didn't say the same for before made me query the need... ?

Did your consultant discuss how they would manage your labour if you take the heparin?
I injected Fragmin throughout my first pregnancy. Because they did not want we to give birth with Fragmin in my system, I had to have a planned induction at 38 weeks where I stopped injecting 24 hours before the induction to reduce the risk of haemorrhage. Would you also need a planned induction and how many weeks early would it need to be to avoid the risk of spontaneous labour starting?
That said, the daily injections were fine and I found them pretty easy to manage once I got the knack ( had some spectacular bruising too though).

@PerspicaciaTick - it was mentioned that if I was to go into labour early the heparin needs 12 hours to be out my system before they would give me an epidural or spinal for a c-section.
I'm due to be induced/have planned section in my 37th week if I get that far. (They won't let me go over that which is fine) which is a factor in my thinking as having had a natural delivery before I have no desire to go through having twins without having option of an epidural or c-section!

Hey @Hobbes39, hope all is going well with the twins. Can’t believe we’re past the halfway stage and starting to think about delivery. I was on injectable lmwh (enoxiparen) from embryo transfer to 15+1 when the hospital antenatal clinic stopped it (before that date no one would take responsibility to stop it!!). I will be going back onto it at 28 weeks and, because I score 4 on the VTE risk assessment (over 40, IVF, twins and high BMI - though that was based on a dodgy calculation and I’d also weighed over 1/2 stone less the same day with a BMI of 28.4), I will stay on it for 6 weeks post delivery. I’ve been on aspirin since the start of my successful IVF cycle and will be until 35 weeks unless I go into labour earlier than this (they are planning a section and aim is to get me to 36 weeks if they can!)

I would definitely take their advice onboard and take the injections. You might not need it for 6 weeks post delivery.

Good luck xx

Hi @Rememberallball - good to hear from you and hope all is well with you?
I think that the reason I'm questioning it s that she left it up to us - so hasn't given an actual recommendation for pre-delivery, but was clear that she considered it worthwhile post delivery... so it's hard to decide.
I was 'discharged' from the ivf clinic and handed over to the 'twin clinic' after our good 7 week scan - so this is the twin clinic consultant that we see.

I don't want to be unfair, but it's been playing on my mind since reading your reply @Teddybear45 - but having read the link and also having done plenty research into miscarriage rates, I wanted to point out to you that your initial post was bordering on scaremongering. Yes, miscarriage rates are high over 40, but as with any age group the risk of miscarriage decreases the further you get along in the pregnancy and to state a flat 50% mc rate for someone 42 is just plain wrong and not very helpful. My IVF consultant did discuss this with us, (a few times as we had miscarriages), but even with my history the probability of mc was lower than 50% once we got our positive pregnancy test. I think you might want to check out this site to help you be better informed before posting something so negative again. I'm on a board with a lot of lovely ladies who are over 40 and TTC and while obviously it's good to be realistic, misleading info like your initial claim can be very disheartening. datayze.com/miscarriage-chart.php

That’s pretty much what I was thinking too Hobbes. Very much scaremongering to be posting that for someone already well past the risky stage. Glad you and the twins are doing well still :)

I got that link from Tommy’s. I don’t believe it’s scaremongering at all. Need to understand the facts.

Thanks @Karigan195 - I'm relieved I wasn't the only one..!
@Teddybear45 - i understand you may mean well, but yes, you do need to understand the facts. If I hadn't have been relatively well informed your post would have frightened the bejesus out of me!
Yes, once you are 42 or over, approx 50% of pregnancies may well end in miscarriage, but as your 2nd post suggested, that is the cumulative stat - so that's from the moment that an egg is fertilised and tries to implant. The VAST majority of these miscarriages happen very early - what is often called a 'chemical pregnancy' - and often people don't even realise the have had a miscarriage as they just have a slightly heavier period about the time their period was due. For my personal circumstances (I was 41 when I conceived, now 42, I've had 1 CP and 3 early MC, but one baby 5 years ago) my MC probability was approx 40% on the day I got my positive pregnancy test. This rate, as with anyone of any age, goes down with every day that your pregnancy continues. By the time a woman age 42 reaches 12w the risk has dropped to about 4-5% and continues to decrease every day things progress.
It IS scaremongering to write what your first post said in response to mine, where I stated I was 22w along. It's also a bit misleading to say that "stillbirth rates are fairly high" for older women - again, they ARE higher than for younger mothers but they are still below 1%. I hope that if you are pregnant and have been worried that this might reassure you.