MTFHR, heparin, and delivery

[Anonymous]

Hello,
I have MTFHR (a blood clotting disorder), and I'm currently taking lovenox. In order to have a birth that is not an induction, my specialist says that I would need to go off lovenox and on heparin (apparently there is a reversal agent for it). The problem is that my specialist says his patients have not been able to get heparin since the melamine contamination problems. I know of pregnant mothers in other parts of the country who are taking heparin now.
I'm wondering if anyone in this area is taking heparin or has taken it recently. I'm not due until February, so I have a bit of time.
Thank you!

[Anonymous]

Curiously, are you homozygous? Do you have another clotting factor as well? I haven't heard of anyone on lovenox for just MTHFR...

[Anonymous]

I had a blood clot in my leg in the first trimester, which led the doctors to prescribe the lovenox.

[Anonymous]

Oh, and they think it was due solely to the MTHFR? Sorry for your clot - I hope all is resolved now...

[Anonymous]

I have MTHFR too, but was only on aspirin therapy not injectables. I was also induced. I didn't want it either, but when it comes down to it, does your desire for a "natural" birth outweigh the risks to your baby? Someone put it to me that way towards the end of my pregnancy and it really put things in perspective. And there really are risks to your baby. I know someone who lost their baby in the last weeks of pregnancy from this (she didn't know she was at risk until the unthinkable happened).

Please, just relax about the induction. If you have good doctors that your trust, just listen to them. They really only have your baby's best interest in mind. (And, to allay your fears, being induced isn't really that bad.)

Good luck!

[Anonymous]

I was on lovenox (compound hetero MTHFR and factor II) - ended up going into labor 5 wks before induction approx 8 hours after my last Lovenox shot. Got to hospital and was intiially told I might be SOL for epidural bc of recent Lov. shot, but they did some sort of blood work panel on me and my numbers were such that the anesthesiologist was OK with administering an epi (I got approx 16 hours after my last Lov. shot). My doc said that some as a matter of policy won't touch you if you haven't cycled off Lovenox, but the doc on duty dug a little deeper before making the call. (thank g-d. epidurals = best.thing.ever)

I know that doesn't directly answer your question, but I did want to throw out my anecdote that happy endings can happen even if you don't cycle off.

[Anonymous]

I too am on Lovenox and will have to be induced when delivering. I was wondering -- do doctors want to avoid C-sections in patients with histories of blood clots or blood clotting disorders?

Thanks.

[Anonymous]

I don't think there is a particularly high concern there, as you will be on Lov for 6-8 weeks pp anyway....Its just like any surgery, Drs will have to be aware of that to treat with thinners afterwards, but I don't think there are any particular concerns.

The only issue is if you have a C, youll most likely have to be under general anesthesia if you are still on the Lov and have not cycled off - for same reasons as needing to cycle off/get induced, etc.

[Anonymous]

I also have a blood clotting disorder and am currently on Lovenox. I am switching to Heparin this week and have found that there are local pharmacies that carry it or can order it. If you do want to switch, just be sure that you leave enough time to find it in case you cannot get it the same day. If you are very concerned about it, you should also discuss your induction options with your OB and high risk OB. If everything is going well and you get frequent monitoring, you may not have to be induced early.

[Anonymous]

Anonymous wrote:I have MTHFR too, but was only on aspirin therapy not injectables. I was also induced. I didn't want it either, but when it comes down to it, does your desire for a "natural" birth outweigh the risks to your baby? Someone put it to me that way towards the end of my pregnancy and it really put things in perspective. And there really are risks to your baby. I know someone who lost their baby in the last weeks of pregnancy from this (she didn't know she was at risk until the unthinkable happened).

Can you please be more specific? None of my doctors have indicated there are any serious risks. I'm being monitored weekly (by two different doctors) and plan to go natural. All I've heard is that the issue is with the epidural.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I have MTHFR too, but was only on aspirin therapy not injectables. I was also induced. I didn't want it either, but when it comes down to it, does your desire for a "natural" birth outweigh the risks to your baby? Someone put it to me that way towards the end of my pregnancy and it really put things in perspective. And there really are risks to your baby. I know someone who lost their baby in the last weeks of pregnancy from this (she didn't know she was at risk until the unthinkable happened).

Can you please be more specific? None of my doctors have indicated there are any serious risks. I'm being monitored weekly (by two different doctors) and plan to go natural. All I've heard is that the issue is with the epidural.

Sure. My docs said that it was better to induce early (39 weeks -- when the baby is sure to be fully "cooked" to use his terms) than let the pregnancy go and risk a clot for me and the baby. The risk of a clot doesn't go away, so better to get the baby out as soon as they can. By 39 weeks the baby is ready to come out. I really wanted my labor to happen "naturally" and for the baby to come when she was ready and not forced to come sooner. After my friend put it to me that the baby's life is more important than wanting labor to happen my way, I was on board with the induction. My friend's baby died of a clot in the last weeks of pregnancy when she would have been monitored and induced early (as she was for her next pregnancy and got a healthy baby).

[Anonymous]

Anonymous wrote:I too am on Lovenox and will have to be induced when delivering. I was wondering -- do doctors want to avoid C-sections in patients with histories of blood clots or blood clotting disorders?

Thanks.

I recently found an article in the Nov. 2007 issue from the American Journal of Obstetrics and Gynecology that mentions this issue and that you might find interesting. The article is called "Antithrombotic therapy and pregnancy: consensus report and recommendations for prevention and treatment of venous thromboembolism and adverse pregnancy outcomes."

The report said "The patient should also be counseled that vaginal delivery is preferable to cesarean delivery, with cesarean delivery reserved for the usual maternal and fetal indications." It continued "Another alternative is to schedule induction of labor with discontinuation of the LMWH to achieve the ASA guidelines. However, it should be emphasized that induction of labor in a patient with an unfavorable cervix may increase the risk of cesarean delivery, which should be avoided if at all possible because of the risk of VTE or major hemorrhage."

LMWH = lovenox
VTE = blood clot
thrombosis = blood clot

It's a long article, and it says a lot more. But it required some translation effort for me to understand the medical terminology.

[Anonymous]

Sure. My docs said that it was better to induce early (39 weeks -- when the baby is sure to be fully "cooked" to use his terms) than let the pregnancy go and risk a clot for me and the baby. The risk of a clot doesn't go away, so better to get the baby out as soon as they can. By 39 weeks the baby is ready to come out. I really wanted my labor to happen "naturally" and for the baby to come when she was ready and not forced to come sooner. After my friend put it to me that the baby's life is more important than wanting labor to happen my way, I was on board with the induction. My friend's baby died of a clot in the last weeks of pregnancy when she would have been monitored and induced early (as she was for her next pregnancy and got a healthy baby).

Not to keep belaboring this, but did you friend stop taking the blood-thinning medicines? Did she have any additional clotting disorders? I'm seeing my specialist tomorrow and wanted to discuss this with him but also wanted to understand exactly what happened to your friend. Thanks for any additional information you can provide.

[Anonymous]

I didn't quote the PP right - here was my question

Not to keep belaboring this, but did you friend stop taking the blood-thinning medicines? Did she have any additional clotting disorders? I'm seeing my specialist tomorrow and wanted to discuss this with him but also wanted to understand exactly what happened to your friend. Thanks for any additional information you can provide.

[Anonymous]

Anonymous wrote:I also have a blood clotting disorder and am currently on Lovenox. I am switching to Heparin this week and have found that there are local pharmacies that carry it or can order it. If you do want to switch, just be sure that you leave enough time to find it in case you cannot get it the same day. If you are very concerned about it, you should also discuss your induction options with your OB and high risk OB. If everything is going well and you get frequent monitoring, you may not have to be induced early.

I was wondering if I could ask who your doctor might be? I am currently at Georgetown University Hospital and seeing Dr. Landy (OB) and Dr. Kessler (hematology). Landy seems open to the idea of switching me off of Lovenox and onto Heparin so that I could have the possibility of not inducing. Kessler seems resistant to put me on heparin for some reason.

Any thoughts? I'd love some advice. Thank you!