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**Mommy97** · 01-10-2009, 03:45 PM

I can't give you any information on your personal medical situation but I can tell you about mine.

I was on Lovenox twice a day during pregnancy with our son due to history of developing clots that ended up doing to my lungs, in two previous pregnancies.

My doctor did not make up his mind to induce us until almost a week before we were induced. Up until that time I went for monthly growth ultrasounds and had weekly NST to check on our son's development, fetal heart rate and activity level. Nothing showed cause for concern, in fact our son was a "very active fetus" and was a week a head by growth ultrasounds so at our 37 week appointment our doctor made the decision to induce so that I would have time to go off the Lovenox and so I would be laboring in a controlled environment "just in case."

I stopped the Lovenox the day before our induction date. Before I was able to receive the epidural they took blood work and told me CBC (I believe it was) had to be above a certain number. My number came back well above and I had the epidural with no issues or complications at all. After birth my doctor gave me some pill I no longer remember the name of, to help my uterus contract (and contract it did) for 24 hours to reduce risk of hemorrhage.

You may want to call hospital you are delivering at and ask to speak with the head anesthesiologist. Tell them you are on blood thinner and baby aspirin and see what they have to say as far as an epidural is concerned.

**Bill Cusick MD** · 01-12-2009, 12:40 PM

Most stop baby aspirin at 36 weeks-

re: heaprin talk with anesthesia, they each have their preference- in general, as long as you have been off for 3- 12 hours, ok for epidural

**lvazquez** · 09-09-2009, 06:34 PM

Placental abruption - refused Heprin pump

I really wish that I had known about this forum in January. Boy, did I need more information. Let me tell you a bit about my history. I have 2 living children. Both preemies. One born in 2005 at 32 weeks. I was admitted to the hospital at 31 weeks 4/7, put an magnesium, had high BP's, and off the chart amounts of protein in my urine ( severe pre-eclampsia). Delivered a 3 lb. 2.8 baby boy and he'll be 4 this November. Amazing! Had another boy in 2007 at 34 weeks 4/7. With this pregnancy we had weekly NST's and ultrasounds at 32 weeks. At one of the ultrasounds it was discovered that I had lost tons of amniotic fluid and I delivered that afternoon. I got to take him home, but he was severely jaundice for 2 months and we did heel pricks every 2 weeks and the at hone bili blanket. And then, my final pregnancy. It was another boy and I was going to get my Three Musketeers afterall. I saw the same OB (bless that man) and things were great. He recommends me to see a Specialist which I do. This doctor ordered lots of bloodwork. Results came back 1/8/09 and said that I have Factor V Leiden and MTHFR both heterozygeous. Recommended a Heprin pump at 22 weeks till delivery. Didn't really explain all that would go into it until a nurse from "Matria" eas calling to schedule an at-home visit to educate us on IV's, etc. I didn't do a pump with my other two, don't have a history of blood clots, no family history either, so we didn't do it? Stupid or smart? I'll never know. that same day, my OB whom I had for all 3 pregnancies, tells me that the practice is letting him go because he hadn't invested, etc. He refers me to another OB in the practice. I should've insisted to see someone with lots of experience with hihg-risk patients, but we spent most of that visit talking about him, not me. I had 2 OB visits with this new OB on 2/5 and 2/19. On 2/19 I am 28 weeks telling her about my swelling issues, etc. I am very concerned, but she wasn't. For whatever reason, my next appt. wasn't scheduled until 3/9 (more than 2 weeks out). On 3/3 I felt the baby do a huge flip and kick - the strongest ever of all my pregnancies. I think that's when he died. Two days later I have discomfort in my pelvic region. I call her around 5 ish and she calls me back. Don't worry, it's nothing, you're still only 30 weeks, it's too early, rest, elevate feet, and get help with the kids furing the day. Three and a half hours later, I have cramps. Is it gas? I try to use the restroom, nothing happening. No spotting, but major cramps and having never been in labor, I knew something was wrong. I took Tylenol to see if that would help any and it didn't. I woke up my husband and now it's after 11 p.m. I tell him I am going to the hospital. I drove myself. I live about 25 minutes from the hospital, but doing 75 mph, I got there in 8 minutes! As soon as I got onto the freeway, I feel the trickle. Doing my kegels to keep it in. As soon as I park and step onto the sidewalk approaching Maternity, my water breaks. There was a mess of blood everywhere when I changed into a gown. Ten minutes or less, fetal heart monitor comes in. No heartbeat. After surgery, it was explained to me that when my water broke, the clot that had formed had opened up and I was bleeding out. had I gone on Heprin, things could've been worse. I had 3 consults in the hospital. One saying that I wasn't at fault for NOT doing the Heprin considering all of the family history, Perlow says we'll never know, and I don't know what Foley said. My Specialist of course wodl argue that if I had done the Heprin, there wouldn't have been a clot. I guess I'll never know. After holding the baby, I could not approve an autopsy, so we'll never know if the clot caused the abruption or what happened first exactly. Healthy baby boy from what we could tell - precious. He was longer and heavier in weight and was 2 weeks earlier than my first son. Those stats hurt because I know in my heart that he would've been okay. Never had a 24-hour protein screening and when I told her my symptoms, I should've been in her office every week like my first pregnancy. I had sterilization. I cannot do IVF for myself and I am now looking into gestational surrogacy. I've looked into medical malpractice as well, but I've been told that my case is complicated and complicated is hard to prove and hard to win.

This is what I want to know . . . given my history of my other 2 pregnancies, the refusal of the suggested Heprin pump, should I have been seen on a weekly basis? Should there have been a 24 hour protein screening? Should there have been more done for me at 28 weeks+? Anybody think this was negelctful? I'm ANGRY. I believe that had my original OB remained my OB, he would've taken these measures and looked out for me remembering the other 2 situations. I was at home on bedrest since 21 weeks, waiting for someone to tell me it's time. What is the point of having an OB if you are left to self diagnose? Anybody?

**Bill Cusick MD** · 09-23-2009, 01:05 PM

Nadine-

most stop baby ASA by 36 weeks as can affect platelets for up to 7 days (although low doce ASA not shown to increase problems with epidural)

d/c heparin based on indication for treatment- clears pretty quickly, ways to medically reverese- alot is based on preference of anesthesiologist, and since they are providing the epidural they make the call

pre-delivery consultation w/ anesthesiologist at your delivery hospital is the recommended approach to establish a delivery plan

ec

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