Lupus Anticoagulant

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Looking for information or experience there is so much conflicting information on this! I have been on heparin since a positive pregnancy test after 2nd round of IVF. Previous tests from MC showed positive for lupus anticoagulant. Currently 14 weeks and all good so far but being closely monitored. Doctor has said I would likely be induced at 38 weeks and heparin stopped beforehand. I understand the reasons why just trying to find out if this means a C-section and will it affect what type of pain relief I can have? I have no history of blood clots or DVT just raised levels on the test.

induction means induction of labour not a c-section - there are pros and cons to each and they'll be able to discuss with you nearer the time what those are in the context of how your pregnancy has been going at that point and what your preferences are so that you can make an informed plan.

I had a planned section booked. I was told not to take it the day before. Went into labour a week before, and having taken heparin the day before as usual had the section with gas and air whilst in labour and the spinal block as planned for the section. All went perfectly, wonderful relaxing experience. Discharged 10hrs later, super swift recovery. It was perfect!

So they book you in early (ie 38 weeks) in the hopes that labour doesn't start by itself before then, because yes if you are heparinised at the time of delivery your pain relief options are limited. There is also a risk of excess bleeding during the birth because of your blood thinners. The usual advice would be 'any notion of labour' hold your dose...but we all know how unpredictable labour can be, so I always find that one a bit unhelpful😅 The logic is if you have a date for induction you'll skip your dose and have the option of epidural, and also less risk of excess bleeding during the birth. There are pain relief options available if you are heparinised but often not as effective. You'd usually meet with anaesthetics in pregnancy to discuss that in more detail. There's a certain number of hours you need to be off heparin to get an epidural or spinal. So in an ideal world you have your planned date and nothing kicks off before then.

That’s so helpful. Thank you

I think I took my last dose of heparin at 11pm the night before and there were no issues with getting my spinal for a section the next day. My section was booked at 39 weeks, but the little one had other plans!! It really was best, so chilled and relaxing, I had to wait for a slot to come free as it wasn’t planned for that day, but the gas and air was great. Had my music playing, husband holding my hand. It didn’t feel like I was in theatre at all, just so calm and magical. I highly recommend it. I think I had to continue with the injections for a couple of months after. We all had a celebratory lunch out 3 days after the birth, it was a lovely time.

Good luck, it’s so exciting! Please don’t worry about the heparin, it wasn’t an issue at all for me.

Just to add, my consultant always advised taking the aspirin and heparin at night for this reason.

I think the recommendations are to wait 4hrs between your injection and the spinal block, so it’s rarely an issue.