Anyone had/have PE? Worried about birth...

[Carhar]

Hi,

On Monday after a load of tests and scans I was diagnosed with a blot clot on my left lung (I thought I just had a chest infection). I'm now on a course of blood thinning injections for the remaining weeks of my pregnancy.

I have now been referred to an obstetrician and cannot have my baby in the midwife led unit (I wanted a water birth). I have an appointment with the obstetrician and hematologist next week but really worried about what it means for this ones birth. My last labour was pretty quick and she was back to back. I've been told I shouldn't inject the blood thinner 24hrs before I have this baby but I only new I was in labour 6 hrs previously!

I would appreciate any guidance as I have no idea what to expect or how it will impact the rest of my pregnancy.

TIA X

 

[petitpas]

Hi there, you just stop the injections when you go into labour and tell the hospital when your last injection was. What the time limit is about is that it is not advisable to put anaesthetic into your spine until a certain number of hours after your injection. So, if complications were to arise quickly then they would use a general anaesthetic.

I've also had clots in the lungs in the past but in my case we decided to go for a planned c-section with my son and the same, hopefully, for baby number two. My worry is that if I go into labour before my date I won't be able to have a spinal and would miss the birth by being put to sleep I'm on a very high dose so my time limit before being allowed a spinal or epidural is 48h.

By the way, you will probably have to continue the injections for at least six weeks after the birth... I hope they prepared you for that

 

[Carhar]

Thanks for your response. I was told last week I will need to continue with the injections if I breastfeed for 6 months

Wow, mine seems very low level in comparison. I know it's only a small clot but my me has said I will be wired up throughout labour to monitory heart rate.

I would prefer a natural labour, but there is a lot to be said about being able to plan a csection especially with a toddler!

Fingers crossed it's nice and straight forward c

 

[petitpas]

That's odd. I don't know what they meant about breastfeeding
I don't know the circumstances of your clot but basically they will decide a length of treatment or even whether you will be on lifelong anticoagulants. As far as I know you can also take warfarin whilst breastfeeding so if they wanted to they could switch you a few weeks after the birth. Personally, I actually prefer the injections. There is less monitoring involved. In any case, though, the length of treatment has nothing to do with how you feed your baby. Perhaps, just the type of treatment (they may not know the effect of the new anticoags yet on babies).
I hope that makes sense?

What a shame about the monitor although I hope you can still have a relatively active labour if that is what you want Usually, if all is well with you and the baby there is a little room for negotiation...

 

[sethsmummy]

you should still be able to move around with the monitors hun thats what iv been told this time anyway. I wont be forced to stay on the bed.

would you be comfortable asking for a planned section? I found my section with ds2 was fantastic even with a toddler at home xx

 

[Carhar]

I really would prefer to have as natural birth as possible and avoid a csection. However, I would rather have a planned section than an ecs. I guess that I'm just going to see what they say after my bloods tomorrow.

Not sure about the injections it was the chest consultant that said I would need to continue if I breastfeed.

Bit worried as had carpel tunnel and lots of cramping in my legs. Starting to think I am paranoid x

 

[petitpas]

Try not to panic, while you are on blood thinners it would be very unlikely for you to suffer another clot If you do have symptoms, I'm sure they won't mind at the hospital if you go in to be checked over.

As far as I know, the majority of women after clots are encouraged to attempt natural birth so do speak to your team. I'm sure they will do all they can to help you have the birth you want (obviously, as long as there aren't other factors that might make things dangerous)

I suffered from carpal tunnel when I was pregnant with my son and I'm expecting it to come back soon *sigh* It's so annoying! Do you also have restless legs? My right foot seems to have a mind of its own

 

[sethsmummy]

good luck with your appointment hun. Make yourself a list of questions you would like answers to hun. i always find that helps.

i have carpal tunnel.. i had operations in 2006/2007 on both hands to resolve it but its come back through each pregnancy and stick around for quite a while after.. so annoying. The cramps in your legs might be normal hun its quite common in this stage of pregnancy xx

 

[Stacey_Ann]

I am on lifelong anti-coagulants after 3 unexplained DVTs, 1 before children, 1 during my pregnancy with my son and 1 last year (thigh and groin).

During my first pregnancy i was on the injections from 20 weeks until 6 weeks PP. I had a natural active labour and birth and was also told the 24hr thing, as prev poster said that's basically you just telling the me last time you injected. I was able to labour in the birth pool and came out when I needed to push. My consultant was happy for me to birth in the pool, the MW was more anxious so we compromised! My labour and birth was very straightforward, monitored by the doppler.

This time round I was on warfarin whilst TTC so switched to injections the day after I got my BFP. I switched from 1 a day to 2 a day at 20 weeks, consultant said it metabolises better so the 24hr got cut to 12.

My labour this time was very quick, about 2.5hrs active I estimate, 4.5 in total. I estimate as when I got to the hospital, 8 minutes after my daughter was born lol.
My consultant and MW's were happy for me to have the birth I wanted as I'd had no complications during pregnancy so I was okay for water birth etc.

It's worth an ask and also worth pushing for if there are no other risk factors etc. both times my blood loss was well within normal range so even though complications are possible they're not a given

Xxxx

 

[petitpas]

Whoa, Stacy, you had a DVT before children but they still didn't put you on injections until 20w with your first pregnancy? That sounds pretty negligent

 

[Carhar]

Well they've increased my dosage as my heparin levels are low. I guess it as when they took my blood I don't think I actually bled like I use to do.

Back again next week for another blood test and to see the hematologist.

Wow Stacey I definitely have had it easy in comparison! I'm worried about a quick labour as my parents will be looking after my DD and they live over 30 mins away.

The birthing pools are only in the midwife led unit at my hospital and they've said I'll have to be in the consultant led L&D.

4 weeks today until my EDD X

 

[petitpas]

What a shame about the birthing pool

Not everybody does but I get my blood checked regularly to see how effective the heparin is (I'm on a smaller target to most). It is the anti-Xa (X meaning 10) levels they check if you wanted to look the blood test up. I've had my dose upped a couple of times this pregnancy.

 

[purplespecs]

I had a PE after my first so I started Clexane as soon as I fell pregnant again. My first labour was very fast at 3h 35m from start to finish and I suffered a severe postpartum haemorrhage (3 litre loss) so once I was on Clexane for my second pregnancy I was incredibly worried about stopping the blood thinners in time. I had a planned induction at 38w (was going to be 39 but I developed other complications) to make sure I stopped taking the Clexane 12 hours in advance of labour starting. They also had drips ready and blood in the room in case I had another PPH. This time I only lost 150ml so it wasn't needed but I'm glad all the precautions were in place ready.

 

[Carhar]

I'm terrified as they have increased my dose again but my blood appears to be fine. Even the hospital nurse commented on it when she took my bloods.

I'm really fed up as I had a follow up appointment. I was 30 mins early and still not seen almost 2.5 hours later. When I was called in I was told as I was late the hematologist had left! It turns out the nurse hadn't passed on my notes although they had my hospital file.

I'm 37 weeks and have no idea what's going on as the obstetrician although nice enough is extremely evasive. Basically been told to call as soon as I think I'm in labour and stop the injections. I still haven't been told by the hematologist/obstetrician what to expect, what PE means such as restrictions etc and highly doubt any precautionary measures have been put in place for my labour. Everything I know is through googling and the lovely ladies on here.

Thankfully my community midwife is still in contact and extremely supportive. She wants to see me next week, but unfortunately I live between two hospitals and she works for the other hospital.

Sorry for the rant x

 

[petitpas]

Oh no! That's not fair about the appointment Can you call the hospital switchboard and ask to speak to the haematologist's secretary? I'm sure that if you explain to them they'll sort you out

As for the appearance or flow of your blood you wouldn't necessarily notice whether you are on heparin or not. I have a huge vein the phlebotomists love. I can always give blood on the first try and sometimes it squirts at them but recently I had a blood draw and it was flowing very very slowly. Yet the results of my test showed that my blood was quite thin.
I found warfarin to be a lot more obvious when I was on it.

Anyways, I hope you get your answers from the hospital soon. Worst case, you arrive at the hospital and let them panic if they haven't got all the info. There is usually a haematologist on call who can help them out.

 

[Carhar]

Spoke to my mw who explained a little bit more about it. She called the hospital asking for a senior mw to call. Typically I missed the call and they said you have an appointment next week and to ask my questions then. Helpful.

Anyway, one of my injections seems to have gone a bit wrong. I have had swelling and bruising but this time it's really painful it feels like it's on fire. Any advice? I have been using ice and paracetamol x

 

[petitpas]

Ouch! I've not had that before. The worst I get is the odd ball under my skin. And bruising, of course. Can you go see your gp about it? Maybe you have a little infection or some form of phlebitis? Sorry, I'm just guessing there...

 

[Carhar]

Thanks. It woke me up last night. Paracetamol seems to have kicked in but think I'll call my GP to see what they say x

 

[Carhar]

I've been told I caught a blood vessel. It still feeling burnt a few days on now. The hematologist seemed unconcerned by it. She was going to look at it but then the obstetrician came in and it was forgotten.

Anyway I now have answers to my questions and a scheduled induction date of 41 weeks. I hope this lo arrives beforehand x

 

[Tasha]

How incredibly frustrating for you.

I've always been told to have the last one 12 hours before since that is how long they last. Odd how they all give different advice isn't it?