Deep vein thrombosis in pregnancy

[newbishad]

Hi there,

I have just been diagnosed with DVT in the left leg. I am 30 weeks pregnant and have to take Clexane by injection twice daily for the next 6 months. The labour has to be carefully planned because of the risk of heamorrhage while I am taking the drug. If anyone has any experience I would really like to chat with them about it. It all happened bery suddenly and I am a bit confused and stressed.

Talk soon

NS XXXXX

I had a post-natal DVT in my first pregnancy (also in my femoral vein - in the groin). It's actually fairly common in pregnancy and post-natally, and it's surprising that there's so little information about it given to pregnant women and many health professionals seem so ignorant. It's easy to feel panicked - often because the midwives etc are panicky, and also because of media coverage of DVT etc. In fact, DVT is far more dangerous when you don't know you've got it iyswim.

I am involved with campaigning for this charity www.thrombosis-charity.org.uk who have a very good factsheet on thrombosis in pregnancy on their website (click on About and then Publications).

The main thing is that you are getting treatment, which is great. You'll probably have to continue the injections for 6 weeks after the birth, or they may offer you warfarin post-natally instead. Warfaring is a tablet, rather than an injection, but you will have to have your blood tested more often so many people stay on the injections. If you do go onto warfarin, it is completely safe for breastfeeding (despite what several SHOs told me initially) - I breastfed on it for 6 months.

The risk of bleeding in labour is very small I think, but you're not allowed an epidural if it's been less than 12 hours since your last injection. I was advised to do the injections first thing so that if you go into labour overnight (as I did the second time) you will have had a while since your last injection. You are advised to do another injection 6 hours after the birth, so check if they want you to take your own drugs in or if the hospital will provide them.

In between my pregnancies, I was referred to the haematology clinic for tests to see if there was a reason for my DVT but none was found. I injected Clexane throughout my second pregnancy with no further problems. Have you been referred to the haematologist?

Sorry, that was long, but ask if you have questions - this is my pet subject!!

Bramshott,

Thanks v. much for all your information. I've checked out the web page and there is a lot of support there. I'm glad you are doing some work on it, because it does need to be highlighted. I was very lucky that I knew the signs of DVT because my sister had it. I am also lucky that I live in an area with an excellent maternity service who listened and responded apropriately, I was admitted within 1/2 an hour and scanned two hours later. I now have support from both the thrombosis team and the maternity service, both of whom will plan my labour.

I have to continue the injections for 6 months and I am getting more info from the thrombosis team next week which will include a labour plan so I will probably have loads of questions then.

Mikofan,

That sounds like a bit of a nightmare. Were you closely followed?

Thanks once again for all your support.

NS XXXX

bramshott-must look up that website!

hi ns. glad you're getting so much good advice. i'm learning things here!

mine was in my groin/top of thigh area too, though it was below my knee that was really swollen . didn't realise at all that it was so common!

cant believe you have a nearby thrombosis team. my hospital had to be reminded constantly by me that i had the bloody thing. i didn't know anything about dvts-i was so scared...

didn't mind the injections at all, but the warfarin clinic was just annoying. i faint when i give blood samples, , dont know why, they dont scare me. so every time i'd have to lie on a bed while everyone around me (mostly elderly people) thought i was such a baby! the few times a new nurse would say 'ah sit up, it doesn't hurt' i would always then puke and faint! mortified.

they never actually scanned me again to see if the clot dissipated. i do worry about that sometimes...i was on warfarin for a good nine months or more. i haven't had a pregnancy since, dd is only just four. and i am single now

hope you're feeling well! x.

newbi - I suffered a DVT and PE several years ago. When I got pregnant I had to inject Clexane throughout to prevent any clots forming.

I was able to have an epidural, as I had spent 13hrs in labour by the time I NEEDED one! They can be given, although your blood clotting needs to be tested to make sure it's safe.

Post partum, I continued with high dose heparin for 10 days (you are at greatest risk at this time). I then reverted back to warfarin for the next 6 months, breastfeeding without any problems.

After 6 months I stopped the warfarin, but unfortunately developed another DVT 2 months later. I will now be anti-coagulated for life.

I am currently trying to for a second baby, and was told that warfarin can cause birth defects partic in the first trimester. I therefore started heparin again in Dec. The consultant has said that he will only prescribe it for 12 months, due to the risk of osteoporosis. That means that I have to conceive by the end of April. No luck so far

Hope you are well, best of luck.

I was closely monitored, yes. I had DD at Queen Charlottes and the guy I saw there was brilliant. I was very lucky that mine was diagnosed because I had none of the normal DVT symptoms. To look at my leg you woudln't have known there was anything wrong. My blood was tested every 4 weeks and when my cell count started going down there was talk of bringing my c-section forward. I made it to 38 weeks with a planned c-section via epidural. I was told that if I get pregnant again (unlikely at 42 but hey) I would need to start injecting straight away

Cheeseontoast - sorry you have had a crap time and a recurrence of your DVT. You might want to get a second opinion on the heparin / osteoporosis risk though, because my understanding was that it was much less of a problem these days with the low molecular weight heparin drugs they have now? It is Clexane you are on, or Fragmin? I took calcium tablets while I was on Clexane because my consultant said it wouldn't hurt.

Newbishad - glad we have been able to collectively answer some of your questions and put your mind at rest to some extent. Great news that you have a good hospital (like MLM, I knew more about mine than most of the health professionals - I used to carry copies of that Lifeblood factsheet to wave in front of all the midwives who said to me "oh how scary, I didn't know you could get on of those from pregnancy"! )

Hi everyone,

Thanks for sharing your stories.There are quite a few of us out there with this, aren't there. I am interested in your story cheeseontoast...my pain threshold is practically zero so it's great they will revert to epidurals if necessary. Also it's my first baby so I expect labour might be a bit longer. Poor you though having a DVT and PE. Good luck with TTC. I have been there as well. Not fun with so many people being pregnant all around you. I hope it works out and we see you on the pregnancy board. All my best wishes and lots of hugs over cyber space.

Mamolovesmojitos, Yes I am extremely lucky about the thrombosis team. I moved back from Ireland to have the baby here in England because my mother happens to live in the catchment area for an excellent hospital. Didn't know I would need it for DVT. I think it's a really good idea that different teams work together for the good of the patient. I was actually rung up by the thrombosis nurse last night because she wanted to ask me how we were getting on with Clexane. (I am a cowerd and DP does injections.) Mikafan you sound as though you were also in a good place. Do they monitor you as routine there or was it because you were scheduled for a C section.

Talk soon.

NS XXXX

Newbi, I was monitored as routine by the clinic I was seeing. I had to have the c-section because DD was still head down at 38 weeks and because of my falling cell count I had to have her at 38 weeks.

Hi newbishad

I had a DVT in my hip at 25 weeks in my first pregnancy, and was on Clexane twice daily until delivery, then Warfarin for 3 months. The delivery was fine - planned c-section in the end - and, once I got over the shock/pain/why-did-it-happen-to-me of the DVT, I felt the best I had felt all pregnancy. All this to day, don't worry, it does get better! I went swimming every day before work after I'd had the DVT. I have no idea whether it made any difference to the healing process, but psychologically it made me feel like I was doing something positive. I also got hold of black compression stockings, as those white ones are just sooo unflattering. There are black (and tan!) equivalent of the hospital-issue TED stockings called ResTEDs. Your pharmacist should be able to order them for you. I think Scholl also do black compression stockings, but I haven't tried them.

As 3littlefrogs said, your haematologist and obstetrician will jointly help you plan for any subsequent pregnancies. In the meantime, try not to worry. Heparin is very effective. I hope your DP is good at injections. I did my own in the end, and it does get easier, I promise! My tip is to inject slowly - seemed to bruise less that way.

Hi Whiteorchid,

Thanks for writing to me. I do feel better and I am walking a lot now. I am so greatful for all the help I have got from Mum'snet.

I don't know about swimming I feel as though I would sink to the bottom of the pool. Before pregancny I used to do a lot (30 lenghts 3 x per week) because I thought it would help the IVF but now I'm not sure if it's for me now.

Yes I have unsexy stockings but I'm getting some new ones from the hospital. Leg is still a bit sore after walking and being up but nothing like as bad as it was before. If you don't mind my asking have you had any more problems with DVT and how did they pick it up in the first place?

Lots of love NS XXXX

Hi Newbishad

Glad to hear the pain is subsiding. I found keeping my leg up when I was sitting helped a bit.

The DVT started with pain in my hip. I thought I'd overstretched at pregnancy yoga. Eventually, however, my leg swelled up and went bluey-purple. I was referred to my local A&E, and they diagnosed it up by doing an ultrasound scan. Well, two actually. They didn't see anything on the first ultrasound, so I was discharged, and went back to work (limping). However, DH nagged me to go back the next day since my thigh was even bigger and more painful, and the radiologist found a big clot in my hip. I was then referred back to the obstetrics/haematology team, who did an MRI to see how far up the venous system the clot was. I have to say I had excellent medical care, long live the NHS! How did they pick yours up?

I haven't had any problems with DVT since then (18 months ago), and my leg feels completely normal now. However, I've since been diagnosed with one of the inherited thrombophilia, AT deficiency, and need to take prophylactic heparin in high-risk situations: pregnancy, long-haul flights, surgery. I expect you'll have a thrombophilia screen at some point, esp. given your family history, but I think they often don't find a cause.

Great thread, by the way, and I'm glad to hear people have got through subsequent pregnancies ok.

All the best with the rest of your pregnancy, and I hope your leg improves quickly.

Hi Whiteorchid,

I am glad to here you have had no further problems. A DVT in the hip sounds pretty nasty...you must have been in a lot of pain.

My DVT is in the left femoral vein somewhere near the knee. I had niggling pains in it for some time but just put it down to muscle strain. Then, the day before I was due to go for my glucose screening test I got a really bad pain in the back of my leg. I couldn't straighten my leg at all and if I rested I could hardly walk on it. I knew that I was at risk because my sister had a DVT two years earlier. I am lucky that I live near an excelent hospital...I was due to go in for a glucose secreeing test. While I was there I mentioned the pain and they had me admitted in 1/2 hour and scanned in the hour. I was kept in overnight and sent home on the Clexane. Thank God I was home rather than in Ireland where I live and work miles from a good maternity service.

I have had a thrombilia screen and there is no cause...it's jsut something we get. I am however, blood group A and I have read the A group are more inclined to get DVT's. I have also been checked for pulmonary embolism because I have been so breathless throughout the pregnancy but it just seems to be pregnancy breathlessness.

Lots of luck and speak soon.

NS XXXXX

Hi Newbi,
Thats interesting about the blood group A being more suseptible - I'm group A too. Also I was told they couldn't do any thrombilia screening until 6 weeks after having my baby because pregnancy hormones can skew the results - just what I was told anyway!

Keep well.
x

Mikafan,

If your interested in the blood group thing I think I read it on the thrombosis web page following up the lead suggested by Bramshott but I might be wrong I definatelly saw it on some web page.

No-one mentioned the hormones screw up the results to me! I will ask in my thrombosis appointment later this week.

Good luck

NS XXXXX

Hi all,

I am just back from the maternity service. Since the clot is small they see no need to induce me early although I won't know for definate until I am reviewed by the thrombosis team. The doctors feel the condition is now stabalised and more problems will be created rahter than solved by induction.

We also found out the flavour...pink! This is slightly strange for me because I have always thought of the baby as a boy.

Lots of love and thanks for all the help NS XXX

Thats good to hear Newbi. I meant to say, it was 8 weeks after I had DD that I had my screening - 6 weeks post partum I had to carry on taking the clexane, then 2 weeks for everything to clear out of my system - then the blood tests.

Good luck with the rest of your pregnancy.
xx

Hello everyone again,

I am just back from the thrombosis clinic and they have told me that I will have to be induced because the clot was discovered so late and they want to control the medication.

Does anyone have experience of induction? How it is done and what it is like? I have heard that induced labours can be more powerful.

Cheers,

NS

I was induced with DS1 but that wasn't with the clot, I'm not sure if that makes a difference. I had pessary's and a sweep and it still took a while for labour to progress, think it took 27 hours from start to finish Did you ask them about the thrombosis screening that you had?

Thanks Mikofan...I didn't ask the question re thrombosis screening because so many other things came up and it went right out of my mind. It's interesting though isn't it how different hospitals have different practices. No-one has mentioned this to me at all. I think most of my treatment is around a. preventing the existing clot from developing and b. preventing another. I do remember them saying on the ward that the clotting of my blood wasn't bad so someone must have tested it.

The team are concerned because the clot was discovered so late on in my pregnancy. That's why I am being kept on Clexane right throughout and the reason for the induction. The good news is that the thrombosis team see no reason why I can't go back for a second helping of IVF but I will have to take Clexane from the day of embryo transfer. Once I have the baby they are happy for me to take warfrin.

Thanks for asking and lots of love

NS XXXX

I was told that I had to go back on clexane as soon as I was pregnant again. Apparently they had examined the placenta when it was delivered and it had some small clots in it though I'm not sure what that meant but when they did the blood screening 8 weeks after DD birth they could find now underlying cause for my clots - just my bad luck I guess.

I hope all goes smoothly with the rest of your pregnancy.