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Protein S + C-Sections


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Yogi - I read you've had 2 experiences with c-sections and protein s deficiency, and to anyone else out there whose had a similar experience can I please ask.....

Did you have a General Anaesthetic? My Haemotologist told me he'd be keen not to do any kind of epidural for a c-section if I've been anti-coagulated. Which would mean a General Anaesthetic. I'd also be very wary of getting any kind of shot into my spine where bleeding risks could increase!

My history is a PE post c-section with my first child..... diagnosed with hereditary PSD... do not take any preventative medications unless long-haul travel and pregnancy and the usual precautions of not sitting still for too long. If and when I get pregnant again I'll have to have Heparin for the 2nd 20 wks, apparently. Also had 1 miscarriage at 7 wks which I don't know if it was PSD related or not, but understand there is a chance it could be. Stillborn stories also very frightening - did we establish whether there is a connection? Would like to consider baby 2, but somewhat frightened of consequences..

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Guest Ellensur

Hello,

I have just found this site,

I was tested for PSD 2 years ago because my nan and grandad both died of blood clots I was told I did have PSD. I have already had 3 daughters all born healthy before I was tested and I am now pregnant again 22weeks.

My blood tests have just come back and the results were low, my midwife does not know what that means and nor do I.

My consutant has recomended 40mg of Aspin a day, plus 6 weeks of heparin injection after the baby has been born.

After reading some off the posting, I am now really scared, talks of still borns and everybody seems to have been taking much stronger drugs.

Do a lot of you live in America, I am from England and nobody seems to know much about PSD.

Help.

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Ellen, some of the best research on PSD has been done out of St Thomas's hospital in London by consultant haematologist Mark Smith. They did a massive study on PSD and pregnancy and i'm really sad that I've now moved to Canada where they know half as much as they did at Tommy's! Get a referral there if you can :rolleyes:

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I should add, one of the things they said to me was that pregnancy, for me, is the "catalyst" if you like for clotting. I have hereditary PSD too and have never experienced any incidents despite over the years variously being on the pill, smoking, or both at once. Pregnancy and a C-Section tipped the balance for me and I suffered a clot and a Pulmonary Embolism. So as an every-day kind of thing, I don't really need to worry about it except for not putting myself unecessarily into any at-risk situatoins such as sitting down for long periods of time, long haul flights without getting up every hour, gaining enormous amounts of weight, etc. If I have another baby I'll have to inject heparin for the last 20 wks as a preventative measure.

Seeing as you have already had kids without issue I wouldn't freak out just yet. Don't do what I did - and sit on your bum for 9 mths eating chocolate and not moving around and gaining weight (thus no doubt promoting clot type situations)..... keep fit, healthy, eat well, and cross your fingers, see a good DR about it, and with some luck and good judgement you will probably be fine :rolleyes:

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Guest Ellensur

:rolleyes:

Thank you for your reply,

My consultant said she was not overly concerned because I have already had 3 children.

I did not realise the seriousness of PSD until I came across this site. I had not started taking the Asprin but I will now.

It just scared me a little bit, I am with a new husband now and we did not think we could have children as my husband has had problems, by now I am pregnant and we are really pleased. We have also just found out it is a baby boy, and as I have 3 daughters we are really pleased aobut that as well.

I have not seen a blood specialist since I have been pregnant so I am going to see my consultant and make sure I am refered to one.

At least that way I will be able to find out what the blood results mean as the consultant does not have a clue.

Once again thank you for the information, and I wish everybody on this site luck with their pregnancys.

Ellen

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katybops,

In reply to your question.\

All 3 of my C Sections were performed under GA. My PSD status was diagnosed well a yr or two after my first Section. The hospital where I had my youngest son prefers to do a section under Epidural, rather than GA.

They knew all of my relevant history, and the fact that I am on Anti Coagulants. Yet, they still offered to do my Section under Epidural.

I was quite suprised at this as I have read quite a bit on it, and have spoken to other Drs. And they certainly haven't suggested it. The end result was a GA as I have had many surgeries on my back. There is alot of scar tissue, and given the fact that I have Spina Bifida, the pathology of my spine isn't " Normal."

I hope this helps you somewhat. :rolleyes:

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  • 1 month later...

Katybops,

I have PSD hereditary, I did have two clots a PE and a DVT at same time. So I was told I had to be very catious when I wanted children. Both pregnancies went OK. I had heparin injections daily throughtout both pregnancies.

I have 2 children my second was by C-Section, I was also told that I would have to have a GA, but when I was admitted into hospital, I was given the option to have a spinal block, this option I took.

I went on to have a healthy little girl, and everything turned out OK.

My best friend has also just recently found out she has Factor V Leiden, she just had a beautiful little girl, a C-Section again, she also had a spinal block.

I suppose each hospital and doctor have different views on this.

I had my C-Section at Grantham Hospital, my friend had hers at Derby City Hospital.

Tinasyn

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  • 1 month later...

I've just read some of the replies regarding epidural C-sections as opposed to GA's. I had an ectopic in 2000 an didn't react well to the GA. When I became pregnant with my daughter in 2001 I had full intentions of having a natural birth but ended up with a epidural c-section as she was stuck. Three weeks later I was admitted with a suspected PE and put on warfarin for 6 months. I have had two years of has she hasn't she as regards PSD and my haematologist has finally decided that yes I have PSD. I am currently pregnant with my second child and had automatically presumed that I would have an epidural c-section again (as well as clexane two weeks before and 6 weeks afterwards) and hadn't given any thought to the fact that I may have to have a GA. Thanks ladies for alerting me to that I'll speak to my consultant ASAP. Has anyone else had an experience like this, its left me a bit shell shocked to tell you the truth, I've been told that unless I decided to suddenly become an air hostess (sic) I've not much to worry about other than 'special occasion' medication but its worrying all the same. My daughter and my brother have to be tested but hopefully they will be PSDless. :rolleyes:

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Hi klb,

I have Hereditary PSD and had two clots a DVT and PE. When I got pregnant I was advised that I would have to have 2 daily injections of heperain, my baby turned breach so I was advised to have a C Section, my Consultant advised that I would have to have GA when delivering. When I got to the hospital they said I could have a spinal block, this option I took, after delivery there wasn't many painkillers that I could take because of the heparin after a few days I was transferred back onto the Warfarin. This I take daily for the rest of my life. Eventually I will have to get both my children tested to see if they have PSD.

I hope you get which ever option you prefer good luck.

Tinasyn

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Hi Tinasyn,

Just thought I'd ask a question.....

In your post, you mentioned that there weren't many painkillers you could take because of the Heparin. Why is that, or what reasons were you given ? :rolleyes:

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Hi Yogi,

The reason I was given was because they interacted with the heparin or warfarin.

I was allowed to take Paracetamol and Codeine, I was on Morphine straight after the C Section but did come off this very quickly.

Why would there have been something else that I could have taken, or are you not sure either.

Tinasyn

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Thanks Tinasyn,

Your reply has put my mind at rest a little. I have to say I've had a bit of a sleepless night. I've made an appointment with my consultant and will make sure that I can def have an epidural - i'm hoping that decisions are hospital specific and that ours doesn't automatically advise GA's. I don't mind so much about the painkillers as I only had paracetamol and codeine last time, I'll just take it a little easier this time round as I'll be at more risk of bleeding. I was a bit 'got to prove myself' last time trying to be dynamo first time mum. I'm glad to hear that there are ladies out there who have had more than two kids, its made me think more about the future, I'd decided that two would be my limit (although I'd like a football team ideally) but now I'm not so sure.

Thanks ladies, I'll definately put this site on my favourites list and let you know how I get on ... watch this space. :rolleyes:

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Tinasyn,

Hi there. I was curious as to what reason you were given, because I had never heard of that before. But in all honesty, the reason you were given makes sense. I was on Morphine after all my Sections for 2-3 days. With the last pregnancy I had many problems and was on and off Morphine for over a week. Not ideal whilst breastfeeding I know :rolleyes:

After that I was on Panadeine Forte. A maximum of 8 tablets a day if required.

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hi Klb

Hope you are well, I can't really add anything to the c-section comments as i have had 3 natural deliveries. I just wanted to say that just because you have had one c-section it doesn't mean that your next child will be born in the same way.

Do a google search for VBAC (vaginal birth after caesarean) and see what you can find out to increase your possibilities of a natural delivery. There is a forum on the ukparents site.

I may be speaking out of turn and you would feel more comfortable haveing a c-section, in which case i apologise. In my case it was my worst case scenario and being on a syntocinon drip to force my little one into a better position and get her out worked (although painfully!!) We are planning for a fourth - but not just yet!

best wishes

orangefoot

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Guest lcurlwillke

Hi, Iam 40 years old and was diagnosed with PSD after the birth of my 2nd daughter june 2003. I developed a DVT in my left jugular vein in my 5th month of pregnancy. I was misdiagnosed after my 1st ultrasound as negative for DVT but as symptoms persisted was subjected to 2nd ultrasound showing large clot. The clot is in quite an unusual location so I was quite the medical mystery woman throughout the pregnancy. The pregnancy went fine and I was on 2 shots of Lovenox per day until 24 hrs. prior to scheduled delivery by c-section. Delivery went fine and I did have a Spinal Block, not general. I took up the Lovenox shots 24 post delivery. I was tested for Protein s and c in this 48 hour period when I was anti-coagulant free. The tests showed I was quite deficent in Protein S and I have been on Lovenox injections and coumadin, now just coumadin, since july2003. I take 15mg. of coumadin everyday it has taken quite a while for the Dr. to get me to "theraputic" levels, between 2.0 and3.0 INR, Iam just now at 2.5. I have a gorgeous baby girl and am feeling relatively well. Iam glad I found this site as I don't feel so odd and lonely now for having this disorder.

Thanks and good luck to all!

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I was tested for Protein s and c in this 48 hour period when I was anti-coagulant free. The tests showed I was quite deficent in Protein S and I have been on Lovenox injections and coumadin, now just coumadin, since july2003.

Hello lcurlwillke - Has your doctor considered checking your family members to see whether you have acquired or hereditary PSD? If your family are okay I would consider getting the diganosis re-confirmed because PS levels are lower during pregnancy and (so I'm told) the test for PSD is bit wobbly after a recent clotting event. Therefore investigations usually start 3-6 months later which is often when people come off their warfarin after a first clot. I don't dispute the diagnosis you have been given or feel you need to worry that your test is wrong (diagnosing thrombosis is the important part, diagnosing PSD is more academic) but would recommend you go back to your doctor and ask about getting family members tested, whether you have acquired PSD or not and coming off the Coumadin for a week (switching to Lovenox or similar) and getting a confirming second test.

(apologies for going slightly off topic here folks)

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