Clexane pregnancy and delivery

[Equestrian]

Hi there, I am usually on life-long (maybe... long story) warfarin but for TTC and PG have been switched to 40mg Clexane injections by my haematologist. I am expected to be on it for the whole pregnancy and possibly after birth for six weeks (although I may be switched back to warfarin, again long story with two haematologists that can't agree about what do to with me. I am on the Clexane to keep me alive rather than the baby, although I believe as a I am a Factor V Leiden carrier my baby is at risk without the Clexane as well.

I am meeting with my new OB next week but before then I would love to hear any stories about how the pregnancy and especially the delivery went. I know I am "high risk" and realise that I will likely need more intervention than I would otherwise want but on the other hand I don't want to get railroaded into things I don't need either, so it would be handy to hear some stories to give me a baseline.

Were you induced early for a predictable labour?
Did you have to get an epidural? (I don't want one!)
Did you have an "elective" caesarian?

Any stories would be most thankfully received.

[ljan]

Hi there

I totally understand your concerns....I am now 13 weeks pregnant with number 5, and the 2nd pregnancy on clexane ( as I have cardiolipin clotting disorder). My Last pregnancy I was put on clexane 40mg from 9 weeks, but due to poor placental function at 20 weeks was also put on aspirin (low dose) and monitored cord blood flow ultrasounds weekly till I was hospitalised at 25 weeks with an elective C section at 31 weeks. He is now 4 and a normal hyperactive boy!!

This pregnancy as soon as I found out (9 weeks) the Dr put me on the clexane and aspirin for added precaution. I have known a number of women on clexane who have carried to term and had healthy vaginal deliveries.

Your tummy ends up fairly bruised and I have noticed that I have had a lot of abdo itching, although I am also on insulin for diabetes, so 6 injections a day is a fair whack!

You will probably find that after 20 weeks ultrasounds may ramp up to check cord blood flow. I know with some clotting conditions they dont like to push past 34 weeks. I will only go to 36 weeks with this one (If I make it!) but that is due to this being C section number 5

Good luck!

[Jules_P]

Hi ladies - I am on clexane (40mg) and aspirin (from 6 weeks) for this pregnancy because I have lupus anticoagulant AND prothrombin gene mutation. We found all of this out after testing for recurrent loss.

My OB would like to keep me on clexane and aspirin until 38 weeks and then induce within a few days (if my body is showing any signs of dilating, etc at this point) or, if there is medical necessity, schedule a c-section. She said if we can go a little longer than 38 weeks so my body starts to get ready on its own, we will as it will make induction easier.

Obviously if things start to change prior to 38 weeks, this will all be revised!

I will also be on clexane for 6 weeks after birth.

On bruising, I was getting terrible bruises until I talked to my OB and midwife about this and I got a proper lesson. I was previously placing the needle on my skin and THEN pressing and it was causing all sorts of dramas. The midwife told me I need to quickly JAB the needle in instead. Let me tell you, this has made all the difference in the world and I have not had a bruise in 9 weeks!!! I also ice the area briefly before and after, and of course, keep the skin pinched for the injection.

[ljan]

Hi Jules P

Have you had to have extra scans to check size and bloodflow?

[Jules_P]

Hi there - other than checks for blood flow at 12 and 18 weeks, I have not had any extra scans for anything. I think my doc said something about IUGR not really coming into play if it's going to happen until later on, like after 28 weeks. (I could be remembering this incorrectly though.) My belly was measuring 30cm at my 28.5 week appt so I don't think she is worried. I think my OB has dealt with women on clexane etc and other high risk situations quite a bit in the past, so I do have a lot of trust in her. That said, it does seem that different docs recommend slightly different protocols for situations like ours.

I briefly lived in Canberra. Who is your doc and where are you delivering?

- Jules

[ljan]

Hi Jules

We are in Latham but have to go through the fetal medicine unit at the Canberra Hospital due to my high risk factors.

Glad to hear all is well with your bub...Our last one was IUGR from 20 weeks, so as I get near 20 weeks I think my anxiety will increase. That said my Professor advised that I have just as much a chance not having another smallie as I do having on!

[Jules_P]

Hi Jules

We are in Latham but have to go through the fetal medicine unit at the Canberra Hospital due to my high risk factors.

Glad to hear all is well with your bub...Our last one was IUGR from 20 weeks, so as I get near 20 weeks I think my anxiety will increase. That said my Professor advised that I have just as much a chance not having another smallie as I do having on!

Sounds like you are in good hands!! It's scary when you reach milestones, isn't it? I'm sure all will be fine!!

[kas]

Hi there,
My story is a little different. I was on Cleaxane for the duration of my 2nd pg until 2 days (i think) prior to being induced. I have rhumatoid arthritis and this bub was IVF. There were a few instances in our TTC that we may have been pg as i would go past my period being due and then a week or so later have a really really bad period. My OB thought i may have been getting pg but just not holding on to them so between my OB/IVF clinic and Rhuematoligist they decided on clexane to help with blood flow for me for my joints but also for bub.
He was born at 38 weeks, i was induced and yes i did have an epidural with no problems. Hhe had been monitired through the pg as he was small for dates, not that anything that i can remember showed on my scans in relation to placental flow, and as they didn't think he was going to get any bigger if they left him till full term we had an early delivery. I can't remember if i was on asprin after delivery, i may have been, it could be in an other post re clexane in pg from a while back if you want to look.
I wish you all the very best with your pg.

[csab]

Hi, my story is different too. After my 1st 2 m/c's I was advised to start taking aspirin thru out my pgcy's and every pgcy after that. I ended up with 2 beautiful DD"s, then had another 2 early m/c's in 2007 until I fell pgnt with another DD. I again had to take the aspirin, but the Drs were contemplating on me taking clexane due to me being ANA positive which was only diagnosed with at the beginning of that pgcy. Although we knew I needed aspirin to help with my pgcy's. It ended up being decided that I would only take the aspirin, yet still had to have clexane injections after bubs was born. I was to take clexane home with me but the hospital forgot. I am now on Aspirin daily, due to my blood clotting disorder, and even tho they dont know what one it is, they have advised me that they may never know.
With all my DD's I had a c/s. The first was an emergency c/s after getting to 8cm dialated and not progressing, closing instead and bubs stressing. My second one was also an emergency c/s after going into labour and the hospital not wanting me to go thru labour. My third was an elective c/s as again I was not aloud to give birth naturally.
In relation to how they managed my care, due to the blood clotting disorder, I had to stop taking the aspirin at 35wks and while in having my c/s I had to wear special white stockings due to my blood clotting disorder. I am not sure on how the placenta was performing, but have always wondered especially after stopping the aspirin with my last pgcy as my DD was only 2.38kg and born at 38wks hospital dates, really 38wks 5days my dates. My last 3pgcy's were also placed under high risk.

Goodluck with your pgcy and I hope all goes well for you and your beautiful little bub.

[ljan]

Its a hard one to know...most women I speak to who have been on the blood clotting drugs in pregnancy seem to have smaller bubs, but then we also have lots of stress (worrying about whether bub will make it, whether something will happen to us etc) and often other medical conditions...still its a great feeling to have that baby no matter what its size, and for those not there yet, know that we have medication to reduce the high risk of miscarriage!

[lanabear81]

Hi all,

i have antiphospholipid antibody syndrome and am on warfrin for life. i was switched to 100mg daily injections of clexane from as soon as we found out we were expecting (4 weeks).

all was going well until i had a 19 week scan last week - the lady said baby was small for GA - approx 16 weeks - but she managed to find everything she needed to - this is giving me some hope that the bub is just small but developing normally. has anyone else had a similar experience? i have an OB appointment tomorrow and am hoping he can shed some light on the situation - have been feeling ok until today - am now really anxious..this is our first pregnancy

reading other peoples posts have helped settle the anxiety!

thanks

[ljan]

Hi Lanabear81

My last pregnancy was exactly the same as what you are going through...At the 20 week scan very small and poor placental flow...Iwas put on bedrest started aspirin (on top of the clexane 40mg) and hospitalised at 25 weeks, monitored every day and ultrasounds 1-2 times a week,with a c section at 31 weeks. Our Ob told us we may not make it past 26 weeks, but we did...I really thinkl the bedrest made the world of difference, and I also increased my fluid intake and had sustagen supplements..I had read this can assist with increasing amniotic fluid (mine was very low due to the IUGR)

He was born 1.275gms at 31 weeks, needed a little bit of CPAP for a couple of days to help him breathe, and the only longer term issues have been gastro oesophageal reflux and a feeding aversion (which have since subsided)...He is one of the brightest at pre school and has amazing energy!

Hope all went well with your appointment....Got my fingers crossed for you!

[lanabear81]

hi all,

unfortunately my fears were substantiated...

my OB found there was very little growth in my bubby and that she had almost no fluid surrounding her.. i was transfered into the immediate care of a fetal specialist who pronounced her dead on the following monday.. i was admited to hopsital on wednesday where i gave birth to my angel baby Matilda Bear.

the haem suggested next pregnancy i try clexane in smaller amounts but twice a day in combination with asprin.. im not sure when ill be ready to think about this...