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PSD-induce or full term pregnancy?


Guest jojo_aus

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Guest jojo_aus

Hi all,

ive just come across this forum after feeling im not getting anywhere with asking my Dr about PSD & deciding to search the web on info of this disorder...Im 38wks pregnant with my 3rd child. orginally i was told i would need to be monitored throughout the pregnancy & induced 1 to 2wks early so as to have a controlled delivery & so as to stop my fragmin that im taking 15000units daily after having a DVT at 9wks. now im under a prof of obstetrics in the high risk unit at a leading hospital.having an ultrasound monthly & then fortnightly my obstertrician tells me the baby is a good size, blood flow to the placenta is ok & unlike pregnancies of this nature ie.PSD, my baby is of good size being even on the larger size & now tells me he will not think about inducing until my due date being the 26th july. i have many concerns & hope i can get some info & feed back from anyone.i have a 14yrG, 12yrG whom i delivered at home(unplanned due to a 40minute labour)i had a stroke 6wks after having her & stopping my injections, 3 days later & on medication for the sezures i had & warfrin for a further 12mths.The Dr didnt start me on the injections until 6wks before i had either of the girls & now with this pregnancy starting 15000units at 10wks after finding i had a DVT.What happens if i go into labour naturally???

2wks to go & hes a good large size with plenty of movement why not induce???

any suggestions of after to prevent a reoccuring stroke or clot like problems???

really scared now after thanking my lucky stars i got through my stroke to be here with my 2 girls.12yrs later & the fears come flashing back.

cheers jojo

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hello and welcome!

It is not unusual for your babe to be of a good size; small babies and PSD are usually only connected when there has been no treatment in pregnancy. Your mega dose of Fragmin will have prevented any clotting problems in the placenta which would cause restricted growth.

Similarly the risk of loss is also significantly reduced through taking medications but is still used as a reason for inducing by many doctors. The other reason for induction is to ensure the safety of epidural by stopping the Fragmin at least 12 hours before induction. If you have had a quick homebirth then that may not be of so much concern to you!

I am 33 weeks now and planning a homebirth. Protocol here is that I will not inject if I think I am in labour or it is getting close, then 6 hours after th birth I will resume injecting and migrate to warfarin (coumadin) after a week or so and stay on that for a year.

The high risk team are concerned about the Fragmin increasing my risk of bleeding after the birth. I have weighed this up and read as much as I can find and the latest review indicates that any increase in bleeding cannot be directly attributed to LMWH but failure of the uterus to contract and restrict the blood vessels left after the placenta detaches, instrumental delivery or c-section.

Here are 2 studies which you might find interesting

LMWH and delivery

LMWH and pregnancy outcome

I am willing to birth outside the hospital and take the small risk of bleeding and induction is also something that I don't consider necessary for myself. If you are comfortable with induction and the risks that go with that then there is no reason not to do it but maybe your OB is happier that babies are left to mature for as long as possible before inviting them into the outside world?

He should have a plan for post-partum treatment taking into consideration your previous history - perhaps continuing injecting for x weeks then taking warfarin for x months. Perhaps the additional input of a hematologist might help?

Try to pin your OB down and agree between you a treatment plan in writing so that everyone knows what they are doing and what is going to happen when.

Best of luck

Rachel

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Guest jojo_aus

thanks Rachel for your reply.I have an appointment at the hospital today with my OB so i will be firing a few questions at him.Thanks also for those links, ive saved them & will take a longer read of them.i feel just in a couple of days of reading this forum & others experiences, gives more info & comfort than ive had in yrs from medicals.i put it down to them just not knowing as they would tell me how rare i am.. although it may have had something to do with me just not asking heaps of questions & speaking up as i have to the people.

Thanks again

JoJo :angry:

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  • 4 years later...

Thanks ladies. I am 22 weeks pregnant. In 2004, I had a stillbirth at 39 weeks and found out I had PSD afterwards. I am on 40ml Lovenox and low dose baby aspirin. Pregnancy is going well. Baby is weighing 1 lb 4oz as of yesterday's appointment with Perinatologist. I also saw OB who just assumed they would induce me because of my history and because I need to be off lovenox so I can get an epidural. I told her I did not want an epidural. I want to go natural. My husband and I said we want to go full-term granted there are no other issues. She was "supportive".

I was encouraged in your post that because the baby is a good size and with the treatments I should be fine. I really wanted a home birth but my husband is against that.

Any other feedback would be great.

Thanks

Tiffany

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Hi

I have had two children, I have PSD and was taking fragmin all way through my pregnancy as well, my first child was born full term I did have a lot of scans to make sure all was well, but I had a natural delivery no problems, stopped taking the fragmin after the birth and was transferred back on to my warfarin after, he is now 15 years old.

My second child again I was on fragmin injections all the way through but because my daughter turned breach on me I had to had a c sectfion, the doctors were very concerned about this I was told I could be put to sleep which was the preferred method or i could have a spinal block so I could be awake through the birth, I opted for the spinal block which they agreed to, it did take me a lot longer to recover after the birth as I was not allowed alot of the medication for pain relief because of the warfarin and psd condition.

I do hope all of your prenancies go well.

I have just found out that my son has psd as well so will be keeping a close eye on him.

Good luck everyone.

Tina

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  • 2 months later...
thanks Rachel for your reply.I have an appointment at the hospital today with my OB so i will be firing a few questions at him.Thanks also for those links, ive saved them & will take a longer read of them.i feel just in a couple of days of reading this forum & others experiences, gives more info & comfort than ive had in yrs from medicals.i put it down to them just not knowing as they would tell me how rare i am.. although it may have had something to do with me just not asking heaps of questions & speaking up as i have to the people.

Thanks again

JoJo :D

After much deliberation we have decided for an induction at 37.5 weeks. I just can't take any risks with this baby after losing one at 39 weeks. I am excited and hope that all will go well and I'll still be able to have a water birth. Inducing on Dec 20, 2010.

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After much deliberation we have decided for an induction at 37.5 weeks. I just can't take any risks with this baby after losing one at 39 weeks. I am excited and hope that all will go well and I'll still be able to have a water birth. Inducing on Dec 20, 2010.

Wishing you all the best for a safe delivery for you and your precious bub, and also for the kind of delivery you're hoping for too.

Can't wait to hear your happy news!

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  • 3 weeks later...

I think any plan to induce, and how critical the timing is, is also impacted by one's target INR. Both of my children were to have been induced, so the midwife could pull me off the Lovenox on a schedule, but both of my children came slightly early before I paused treatment. My target INR at the time was rather low (this was before I had PEs). My first delvery, though, was within hours of an injection. I thought I was having Braxton-Hicks, and she came quickly. Apparently it got a bit scary, but we were both being monitored and all turned out fine. So my second pregnancy I switched to morning shots, since most labors statistically start at night.

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  • 10 months later...

Most recently I was not on lovenox when I went into labor and I hemorrhaged after birth. My daughter( now 3) came early and an induction was planned (she had other ideas) and I did not hemmorrhage.

My doctors this time did not recommend induction unless the pregnancy went over 40wks. I ended up being induced with this one anyways because I thought I was in labor and went to the hosp. to learn that my baby had died during the night. I went to the hospital with contractions but was induced to get the whole thing going full speed since my baby had died. My daughter's birth was different. I think the Dr. wanted to give me pitocin regardless so she wouldn't miss supper. (We didn't use that group of physicians ever again)

I haven't had one birth go the way I would have liked, but I have one beautiful girl (which makes my dr's behavoir forgivable).

I guess what I'm saying is that the recommendations for managing pregnancies in women like us is always changing. It makes it hard to know what to do, especially when you hear so many different stories. Seems to me like the dr's know about as much about birthing as we do, there's a great deal to be said about going with your instincts.

Next time, while I would love a home birth I understand the scary feeling that I might die from bleeding. I wouldn't want that to happen at home. Our children need us. So we do what we can and hope for the best, for life to find its way. It seems there is no silver bullet here.

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