APS & Pregnancy - Being induced early - Advise

[Louise_Davies]

Hello,

I am currently 23 weeks pregnant and I have APS.

Suffered a Sagittal sinus thrombosis (blood clot on the brain) 10 years ago which caused multiple issues (seizure, stroke then brain haemorrhage etc). Almost died, so it was a horrendous time.

Due to this and the APS diagnosis, my pregnancy is categorised as high risk and I'm under the care of a high risk obstetrician, together with my haematologist.

My pregnancy was planned so I had already switched prior to becoming pregnant from warfarin to Tinzaparin (heparin injections) 14,000 per day and 75mg aspirin daily.

They have said from the very start that I won't be allowed to go full term and will be induced at 36 weeks.

Just wondering if anyone else has been in a similar situation and has been induced early?

If anyone has been through similar that can share to help me please.

Just feeling anxious about being induced early and what this means for the risks for my baby and how I can plan for it all.

The obstetrician has arranged for me to have an anaesthetics review, which I'm having next month, as I won't be allowed an epidural or spinal due to the blood thinners.

And I'm having 4-weekly scans and Consultant reviews to check the baby is growing as it should.

If you can think of any questions I should ask the obstetrician, haematologist and anaesthetist then I'd really appreciate it please.

Much appreciated,

Louise.

[lupus-support1 Administrator]

I can understand you may be feeling very anxious, which is why you need to discuss further this with your obstetrician.

I don't know where you live, but St Thomas' Hospital, London has its own pregnancy clinic,under Dr Munther Khamasta, but I have heard he is no longer there. He would have been my first choice of help and support to you.

Professor Graham RV Hughes would also be someone who would be helpful to you.

With good wishes,

Ros

[Wittycjt]

Make sure you ask how long you will be in the hospital and how they will be coagulating you at that time. Try and relax you have a ways to go yet. Enjoy your pregnancy, you'lll have that babe in your arms before you know it. Best wishes 🎉🎉🎉

[starships]

Pregnancy is such a stressful time.

I was induced at 38 weeks but they told me from 24 they may bring baby sooner if we had a growth issue. I have not had any clotting issues myself they have all been pregnancy related. At 36 weeks there are usually very few complications for baby as long as they have been growing fine before then. They may have a little jaundice but if you look in a development book all that has been done before. I have a friend who has had two children first born naturally 36 weeks and then 35 as she is petite so just can't carry till full term which is classed as 37 weeks onwards.

Induction is often slow, very slow. I believed I would go in and have a baby the same day. This was not the case, it took me 3 days to really get going so take lots of reading, snacks etc and get up and walk around the hospital as much as possible for as long as they allow you. They will monitor baby and you regularly with the heart rate monitors, blood pressure etc. Once induction is started you can't leave the hospital but your partner may be asked to go home overnight if you are not in a native labour. I wasn't told this and it was a bit of a shock.

However in hyndsight I wish he hadn't taken the time off work to sit around with me waiting for something to happen so if you feel comfortable with it I would be by myself (or take my mum) in the day and they will call him when you go into active labour or he can come at night after work. Therefore you get maximum time off after birth to be a family on paternity leave.

You are not alone and anytime you need any help you can post again or pm me.

Wishing you all the very best of luck and you are almost there xxx

[Sara_A]

Hi, I have lupus and aps and have had both my babies early at 38 wks one I just had a sweep with tobring labour ona d the 2nd I was induced with a pessary.

I don't have the history u have with the clots but I was on aspirin and heparin daily and growth scans regularly. My 2 were born 5lb12 and 6lb 1 oz all good and healthy. They kept an eye on the growth and thought it was maybe tailing off so got them out as they are better to be out .

They just need to plan it so that they can stop ur fragmin etc.

It all went well with mine and we were closely monitored as u are being which is the best thing x

[INCR]

Dear Louise,

First of all, congratularions on your pregnancy

I can share the experience of my first pregnancy. I am now pregnant with baby no. 2 (15 weeks).

On my first pregnancy I stopped a part of the medication (Plavix) 7 days before labour and I was induced so that I would not be without this medication for too long. I stopped Lovenox the day before. This was basically the anesthesiologist's decision...my obstetrician was (and is) much more relaxed and said that induction was not necessary and that labour would be safe even with me taking medication. This time around, my internal medicine doctor has already told me that induction is not mandatory.

I would advise you to discuss all your options with your doctors. Perhaps you could ask the anesthesiologist about your options on pain relief. Their opinion is highly important but it's also crucial that you fell confident, relaxed and safe. To be honest, I'd like my second to be induced, since I would feel less anxious about the date. But this is purely based on my personal experience and some anxiety

Having APS and being pregnant can be stressful but we have to trust that we're in good hands!

I wish you the best of luck!! We'll be waiting to hear the good news =)

I.

[Louise_Davies]

Thank you for your replies and sharing your stories with me.

They want to induce me early due to the risk of excessive bleeding with being on the Tinzaparin (heparin) and aspirin. They have said I'll take my blood thinners the morning of the day of induction, and then the next time will be once I've had the baby.

And they are trying to avoid a c-section if they can.

I'll certainly ask the anaesthetist what pain relief options there will be.

But I know they've said an epidural and spinal won't be possible due to the blood thinners, and if I have to end up having a c-section then I'll have to be put under with general anaesthetic.

I'm nervous about being induced and having the baby delivered early.

And worried incase this will have an adverse affect on the baby.

Thank you all, really appreciate everything you've shared.

[MaryF Administrator]

Many on here have had an elected early induction. I do suggest you have a chat to the main nurse attached to that clinic, to help reduce any stress you feel. I was induced with my first, not that early one, one week before and it was all fine. Congrats on getting this far. MaryF

[ema_35]

Hi Louise,

Firstly a huge congratulations on your pregnancy - it is not easy planning a pregnancy while being told you will be high risk and knowing all of the 'what ifs'. It is worth it in the end when you hold your baby but still not an easy decision.

Like some other people on this forum, APS mainly affects me in pregnancy so I have not had the difficult experiences you had 10 years ago - that must have been a really horrific time. However, APS does affect me badly in pregnancy. I was on blood thinners (aspirin and 120mg Clexane injections) each day. Both of my 2 cherubs were delivered via emergency c - section under general anaesthetic (my daughter at 27 +1 weeks and son at 33 +4 weeks). It is not ideal, a shock and scary at the time and my daughter in particular did require a fair amount of speech, occupational and physiotherapy. However, they are both now bright and happy and doing very well at school with no lasting difficulties. In the end they and I were both better out than in. It sounds as though they are keeping you very well informed and closely monitored but never be afraid to seek advice or more information in between appointments if you are not sure. I guess my point is that premmie babies can still do very well as the care is exceptional these days (even the really early micro prems at 24 weeks). I have a friend who also has APS and has carried both of her girls to term with no problems so it really is an individual journey. Best of luck and take care for a hopefully long pregnancy. xx