Clexane & DVT & Birth

Hello,
I'm very frustrated with my specialists' treatment of my pregnancy. My Vascular Sugeon and Obstetrician have differing views on what is best for my baby and I. I've been seeing a vascular surgeon because at about 6 weeks I developed a 'spontaneous' DVT in my shoulder. I took clexane 60mg twice a day until the DVT disappeared, around 20 weeks and since then I've been taking 40mg once a day as a precaution to prevent re-clotting during pregnancy. After an ultrasound on my shoulder revealed that they clot was gone, but damage was done to my vein, so that when I 'bear down' or exhale the vein closes and completly blocks off, my Obstetrician stated that it's too risky to push so I'll have to have a c-section. The risk with pushing being that a DVT could form as a result of the delivery (according to Vasc Surgeon). Obst explained that with a c-section there still is some risk with clotting at the wound site or in uterus, but this is apparently less a risk than a DVT forming if I push (and I'm sure there are many medico-legal reasons too). I was initally very upset because I was hoping to have as close to 'nautural' birth as possble, but over the last couple of months have come to terms with this believing that I am doing the best thing for my baby and I.
However, yesterday I visited my Vascular Surgeon and informed him the obs plans of stopping clexane at 36 weeks in case I go into labour early. Reason being the risks associated with bleeding occuring at the site of the epidural. According to my Vasc Surgeon many anesthetists won't do a epidural within 12-24hours of taking clexane (again, medico-legal concerns), but he cannot see the reason for my obst's suggestion of ceasing cleaxane at 36 weeks when my obst has given no indication of any risk of early labour.
I've asked them both before to talk to each other about my treatment and when asking Vasc Surgeon (again) yesterday if he would consult with Obst before my next Obst appointment this Wed he refused stating that I could tell him! I'm paying these specialists a lot of money to take care of my baby and I and they can't even make a simple phone call to each other!!! I'm going back to have another scan on the shoulder at 36weeks to check on the condition of the vein and see if there are any improvements. I am seeing my obs today and will ask him if perhaps I can go on heparin from 36 weeks, as apparently this is less risky than clexane in the case of an epidural needing to be done (which is the way he plans to deliver by c-section).

I would love to hear from anyone who has had/is having a similar experience with delivery and clexane.

I am currently 30weeks, so have 6 more weeks of clexane before being re-assessed after another scan of the vein.

Chels, there are a few of girls on here who have taken Clexane during pg for various reasons, and are quite knowledgable about it (I think a couple of them are nurses). I'm sure I remember one of them saying she had to go off it weeks before her scheduled c-section??????

If you don't get a response down here, maybe you try copying your post into the pg general discussion thread, in the hope that one of them will see it!

Good luck :)

.....

Hi I too had clexane from very early in my 2nd pg due to arthritis. I too was told i would have to stop taking it around the 32-34 weeks as my son would be delivered around 37-38 weeks. As it turns out i think i had the last shot on the wednesday before i went into hospital to rest prior to induction and had Liam on the saturday. I had an epidural but a natural delivery and suffered no excessive bleeding. I did have two lots of gel to get things going on the thurs and friday and my OB didn't seem to have an issue if i did go into the labour only having just stopped on the clexane.

I wish you a wonderful hassel free birth and good luck.

hy don't they just put a shunt in the vein?

I had clexane during my last pg as I had my leg in plaster (broken foot) The ob who was pretty relaxed about everything else was adamant (sp?) that I must be off the clexane 4 weeks before the birth and that if I went into labour early I wouldn't be given an epidural if I was still on clexane. Luckily the plaster was off and I had finished the clexane before I had Riley. I can't believe your vascular surgeon and ob can't talk to each other, my ob and orthopedic surgeon were fantastic together and really shared the care for a while there!
Good luck with everything, I am sure it will be fine its just a bit confusing now.

Just thought I'd update in case there was anyone reading this who may have had the same procedure, or if anyone is just interested.
So, where I left off from last time....I chucked an emotion fueled tanny and my specialists finally wrote to each other. It was decided unecessary to stop clexane at 36 weeks and continue with it until 2-3 days before c-section date. I kept pushing for the possibility of natural birth, which both my obs and I thought I was going to get when I presented to mat ward at 32 weeks with blood loss and dialation to 1cm. Ob was of opinion that prem babies come quickly, so he thought I'd have her that night, but bleed and dialtion stopped and after scan I was discharged 2 days later to bed rest and back on clexane.
The next week again I had blood loss accompanied by pain, so rushed back to hosp. Same thing again, this time had dilated to 3cm, but again all stopped and was discharged once more to strickt bed rest and back on clexane.
Again, at 34 weeks no blood this time, but contractions. Presented to mat ward and admitted. After internal exam contractions were 2 mins apart and looked like bub was on her way! Contractions stopped after 1 hour and I (and mum and DH) slept in delivery suite over night. In am ob on call wanted to do internal again even though the last one strengthened the contactions and put me into active labour! I refused (and wondered about her ob skills) and was discharged once again and back on clexane.
Had only been home for 1 day when readmitted with more contractions and excrutiating pain! At this point I was fed up and wondering if there was something wrong with me (why couldn't I cope with this?!) I was monitored and told they were not contractions but the intense pain were from my 'irritable uterus' (right). I couldn't believe that such pain was not labour as this pain was worse than the pain experienced the day previous when I was in labour! After consulting with ob he suggested that we bring date for c-section forward by 2 weeks so Sophie would be born at 36.5 weeks. After feelings of guilt wondering if this was right thing for bub, as she had handled the whole ordeal fine, it just seemed my body was wanting to deliver her early! Ob assured me at 36.5 weeks she would be fine, perhaps a bit sleepy, but fine. I met with psych to share my worries and finally decided that it was the best thing to do (although, at that stage I was unable to make even the most simple of decisions, so I don't know how I managed this one!)
So, at 36.5 weeks Sophie was delivered by c-section. Far from the all natural water birth Ihad dreamt of, but there were no problems with her and I went back on clexane after the birth.
As suggested, she was sleepy and spent 10 days in ICU nasal gastric feeding until we figured out how the breastfeeding thing worked.

Now, 4.5 months later I face a 1st rib resection (take out my first rib) in 4 weeks time. Spec opinion is very high risk of another clot with subesquent preg if I don't have this procedure. I will be in a lot of pain when I breastfeed her, but I don't want to take that away from her. Of course, there is no garantee that I won't get another clot, but here's hoping.

Oh WOW Chels! Congrats on the birth of Sophie. Wishing you best of luck for your upcomming surgery and a very speedy recovery. You're a very brave and couragous woman! Keep us up to date with the surgery.

MG

Congratulations on the birth of your baby. It sounds like it was very action packed. Wishing you a speedy recovery.

I didn't see your original post.

I am on 5,000iu of fragmin which is the same as clexane. It is not indicated in literature to stop clexane earlier than 24 hours prior to a scheduled induction or 26 hours prior to surgery. Clexane doesn't stick around long thus the daily injections. Once it's gone it's gone with no residue. (I just thought I would state this for anyone on clexane that may be afraid)

I am on clexane for a clotting disorder and for me I require this drug up until the birth and then for the next 4-6 weeks post birth. I will cease the medication 24 hours prior to the birth...

Yep - agree with Deb. I was meant to be on clexane up until birth (until I developed a hypersensitivity) and there was no concern about the need for an epidural or c-section if that was required. Just not take the dose if you are in early labour. The half life (time to excretion) is really short and is the reason why it needs to be taken daily or twice daily.

Hi and thanks to others for feedback. Michelle & Flowerchild my vascular surgeon assured me and my ob that the clexane would well and truely be out of my system in 24hours, but my ob was very over cautious and was playing by his rules (for this and so many other reasons I'll be having a different ob for my second pregnancy!)

Alan, I asked my vasc surgeon about a shunt early on and he said it wouldn't work.

What did happen....I booked in for the rib resection on 5th Sept. The surgery took twice as long as thought (3 hours) becuse my subclavian vein (the one that had the DVT) was stuck to my first rib! The surgeon said it was difficult to pull it off the rib so as not to damage the vein, cause nerve damage or loss of sensation in parts of my arm. He then removed about a inch of rib that cross sectioned with my collarbone. So, lucky I did go ahead with the surgery because if I ceased the clexane the chances of getting another clot were high due it being stuck!
Recovery was long and painful. I tried to but couldn't handle the pain without morphine and when the nurses assured me that Sophie would get very minimal in my milk (3%) and that at the worst it would make her a bit sleepy so I continued to feed her, but dropped from 4 to 2 feeds a day because it was a logistical drama for my helpers to bring her in to the hosp for 4 feeds. They were painful to do, but with help to position her and lot of pillows, I managed.
I was in hospital for a week until I begged the surgeon to let me go home with my drip still in place. I had a lot of help from DH, mum and MIL with Sophie as I was unable to use my arm so therefore unable to pick her up, change her, pretty much hopeless for about 3 weeks after the surgery. The pain I experienced and the time it took to recover was far worse and more extreme in comparison to the c-section I had 5 months prior!!
Now 7 weeks later I almost have full motion of my arm and almost pain free (few twinges here and there if I push it) and best of all no more daily injections of clexane! (after 18mths of it!) Doc says fully recovered by 3 months and gave me the all clear at a check up 2 weeks ago. One final check up in Jan next year cos there is a chance that scar tissue or the possibility of the rib regrowing can cause problems again. So, here's hoping it'll be ok and we'll be able to TTC for #2 soon -yay!
Sadly, I had to stop breastfeeding Sophie a week ago because my period hasn't returned and I want to have a couple of cycles before conceiving again. It's so sad to take that away from her, but I feel like after all I've been through with my health that I have done a really great job giving her a good start for her first 7 months! :clap:

Hi
I am on my first course of Clomid my doctor told me to start taking the tablets on the first day of my period starting. I am taking them during the night and mainly just suffering with hot flushes and blood clots. I am only on half a tablet a day as my specialist advised me i was at the half way point with my hormone levels. Does anyone know the success rate of being on these tablets if they work and i will be able to fall pregnant??? I had a laproscopy done 3 months ago and they found severe endometriosis but they got rid of it during my operation but its starting to come back now as the pains have started again and severe pain during my period. Any information you can give me would be greatly appreciated