Anti-coagulants and induction

Hi Everyone. I am brand new to this forum and only just learning about HS.

I should start by saying that I don't have HS; I'm a healthunlocked user from another forum and it was recommended to me that I post this question here because some of you might have experience that might inform my own.

I developed a blood clot after ankle surgery last year and then fell pregnant while undergoing treatment for the clot so my treatment has been prolonged during pregnancy.

I have just learned (at 33 weeks pregnant) that this means I may well have to be induced on or near my EDD because I have to come off the Enoxaparin before labour but not too long before. So induction is seen as a way to control this scenario.

I would really appreciate hearing from anyone who has gone through the experience of being induced due to anti-coag treatment. Or even people who were on anti-coags but weren't induced?

I'm just trying to get a sense of what my options are and what other people have experienced.

Thanks so much in advance.

18 Replies

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  • Hi, it is fine to pop in and ask us a question, it is true that many on here are induced and their medication controlled. I will ask was the clot on your ankle merely something to do with the surgery or is there any history in your family of autoimmune diseases, thryoid conditions, bad reaction to contraceptive pill, miscarriages, strokes, heart attacks etc, as sometimes the first hint of this disease is something like this cropping up. Also do you have any history of migraines?

    Presumably you are under a haematologist and and an obstetrician who will work out your due date and management between them. I have had three children all safely delivered, I was on Heparin injections. MaryF

  • Hi Mary, thanks for responding. My background is that I developed the clot after ankle surgery. I have none of other things you mention like migraines or autoimmune diseases.

    My brother has Factor V Leiden and had two clots in his leg before diagnosis and beginning treatment for the disorder.

    My father developed a clot after surgery but has been tested for Factor V Leiden and does not have it.

    My mother has never had a clot despite having major knee surgery but her surgery took place in France where everyone is put on anti-coags after leg surgery as a matter of course. She has not been tested for FVL.

    I have not been tested for FVL because they are waiting until after the baby is born and I can come off the heparin.

    Mary, you mention that you delivered all three children safely on heparin. Can I ask whether you were induced and/or how long before labour you stopped taking the heparin (if at all)? Did you choose to have pain management during labour and if so, how did being on heparin affect the administration of the pain management plan?

    Thanks again.

  • I stopped the Heparin the day before, I was only induced with the first one, not with the other two, during labour I had Pethadin, plus gas and air. I do think you should consider doing these tests: hughes-syndrome.org/about-h... Just to rule it out, in addition to FVL

    ncbi.nlm.nih.gov/pubmed/107... Hughes Syndrome, also known as APS, Antiphopholipid Syndrome and Sticky Blood. MaryF

  • Thanks Mary I will read up and educate myself.

  • I was on heparin for my 3 children - taking it in the mornings so that if I went into labour at night I would be clear

    Are you on treatment dose or prophylactic? On higher dose, I ended up taking half mornings half evenings ... I wasn't induced, went into labour night time

    For later pregnancies, I needed induction. For various reasons

  • Thanks Fusch! That's very helpful. I actually don't know if it's a treatment or prophylactic dose. I assume the latter because if not for the pregnancy treatment would have ended a while ago.

  • 4 children, 3 births, I meant!!

  • If you don't plan an epidural and are prepared to risk needing a CS under general anaesthetic, no induction needed just because of the heparin, in my experience

  • Thank you. I had planned an epidural so that is very interesting.

  • If you want an epidural, you can't have it within x hours of the heparin - so if you are not induced, you risk not being able to have the epidural if labour starts at an inconvenient time

    If you are going to have an epidural, no reason to object to induction though? They sort of go together ...

  • Hiya Fusch. Yes it does seem that in this case epidural and induction go together - I just hadn't realised this would be the case as neither my midwife nor my obs consultant had told me this.

    Normally however induction and epidural don't have to go hand in hand and since induction has knock on effects in terms

    of likelihood of intervention that epidural alone does not.

    so the fact that I'm may well be induced changes my preconception of how my labour might progress.

    Thanks for your input. I have a lot to discuss with my obs consultant now!

  • In my experience, Induction is routinely offered in uncomplicated pregnancies once they go past 40 weeks.

    Induction in my experience goes like this:

    Pessary to soften cervix

    Attempts to break waters once cervix becomes favourable

    Things often go very slowly – continuous fetal monitoring is in place and it’s not easy to get up and walk around

    The syntocinon drip is then proposed. This brings on strong contractions very quickly. The woman then wants an epidural which can take a while to arrive.

    Well before the pushing stage both the woman and the baby are fatigued. An emergency CS follows.

    I had 3 births

    No 1, on treatment dose of clexane. With support of midwife, went to 41w + 4, taking clexane in two half doses morning and night. When I started to get twinges, skipped my dose, baby born within 4 hours, no intervention or pain relief needed

    No 2 (twins) Accepted induction at 38w + as twin 1 wasn’t growing. Missed my heparin as instructed. Had waters broken, went into labour almost immediately, baby born within 4 hours. Second baby was in a bad position, had gas and air while they turned her, then synto drip – with no epidural it was pretty awful. But she was born within an hour

    No 3 – had high BP. Was induced reluctantly. I didn’t want to need synto again, wanted a water birth. But after 5 days of the pessary, they still hadn’t been able to break my waters. I had been off heparin all that time (not great!) When they finally managed to break my waters, I didn’t go into labour. They then suggested synto drip. I insisted on epidural first. Epidural failed, but by then the drip was in. Very painful birth, though I did manage to give birth upright. Developed an infection and bladder problems afterwards due to the catheter

  • Obstetricians are very risk averse. If you are concerned about the overall experience, and your control of the whole process, I would suggest you arrange a pre meeting with the supervisor of midwives to discuss and agree a birth plan, that is also acceptable to the doctors

    Get it all written down as your own Dr quite possibly won't even be there on the day, if the birth isn't an induced one.

    No one can force anything on you, though it doesn't feel like it when you are in the middle of it. Any risk is yours to consider and decide upon, you shouldn't feel As if you are on a conveyor belt of interventions

    Am happy to PM about it if it would be helpful

  • Thanks Fusch that's all immeasurably helpful. At the moment I am shuttling between the anti-coagulant clinic (who aren't very labour-savvy, as my ant-coag doctor didn't even know that induction is advised anyway at 40+2) and the obs clinic that deals with expectant mothers on anti-coags, which is, as you say, very risk averse.

    It's so helpful to know of other people's experiences, as it means I have some reference points when discussing with the doctors.

  • My only advice would be to not go blindly into being induced. I was induced with my son (before my diagnosis with APS) just before my due date and all I will say is never again.

    I've already told my consultant, the next next baby will either be a spontaneous labour or a c section.

    It already sounds like you've educated yourself about inductions, increase in likelihood of intervention (particularly in first time mothers) - personally I'd be questioning why medication would mean an induction is needed. Personally I would want to manage my medication in such a way that induction wasn't necessary

  • Thanks SRAC, I really want to try to manage the medication so that induction is not necessary.

    I think inducing mothers on hep is standard, which is of course not the same thing as necessary - but in the public health system often standard and necessary are presented as one and the same and if you don't question and push you can end up on the "conveyor belt" that Fusch refers to.

    This is why I appreciate all these responses, because I can see the wealth of differing experiences people have had and in empowers me to take control of the process - as much as possible - of how I give birth.

  • Another thing To take control of is your own dvt prevention - in my experience, they 'forgot' I needed clexane shortly after the birth, and needed to wear the dvt stockings

  • I was on enoxaparin until 36 weeks, then my doctor switched me to heparin. I was scheduled to be induced, but just in case I went into labor early my doctor switched me over. Heparin has a much shorter half life. I was told if you have had a enoxaparin injection within 24 hours that they will not do an epidural. I ended up developing preeclampsia and was induced a few days earlier then planned but everything turned out great and I have a 15 month old little girl.

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