Tuesday, April 9, 2013

First Birthday

I didn't do 1st birthday parties for my other kids (aside from small family celebrations). But, I really am excited about our plans for our little miracle baby turning one! I think in part because I wasn't sure we'd get to have her. She is SUCH a joy!

Wednesday, January 16, 2013

Hematologists Perspective

Doctors (both OBs and Hematologists) seem to disagree at times about how to treat Factor V Leiden in pregnancy. I recently ran across these two Q & As from the Baylor College of Medicine "ask the expert" site. I would urge anyone who's doctors are not willing to treat their clotting issue in order to prevent recurrent pregnancy loss to seek out a different doctor. Here's what the Hematologist at Baylor says: Subject: Factor V Leiden Q: I have had two miscarriages this year (6 and 10 weeks). My ob/gyn ordered a lot of tests and a chromosomal analysis after my second miscarriage. My chromosomal analysis came back completely normal but she said that I have factor V Leiden Mutation (hetero). I was told that this may have caused both of my miscarriages. My doctor said that I needed to see a hematologist who would determine whether I needed to take children's aspirin or a blood thinner the next time I get pregnant. I was referred to a hematologist who emphatically told me that FVL did not cause my miscarriages. The hematologist told me that FVL would not cause me any problems until the very end of my pregnancy, if at all. At this point, I was real upset because I didn't know which doctor was right. To make things worse, I later read the literature that the hematologist gave me and it stated that "All patients with a history of unexplained fetal demise would probably be treated". Another handout she gave me stated "If you are factor V Leiden positive and you have never suffered from a clot, you probably do not need any therapy on a routine basis. Protective anticoagulant therapy may be needed is situations where your risk for developing a clots is increased, such as during pregnancy and the post partum period". I would very much appreciate any insight you can offer. A: Most studies confirm an association between conditions such as like Factor V Leiden and both early and late miscarriages. Given your history, we would recommend injections of the blood thinner Lovenox 40 mg daily throughout pregnancy (and for 2-3 months post-delivery). Dr. Lawrence Rice or Dr. Kelty Baker would be happy to see you for a consultation, if you wish. The appointment number for both Dr. Rice and Dr. Baker is 713-394-3800. References: Kupferminc, NEJM 340:9-13,1999 or Walker, J Clin Pathol 53:573-580, 2000. Q: I recently tested positive for Factor V Leiden, heterozygous. I am EXTREMELY curious about the relationship b/w FVL and late term pregnancy loss. Any information you could provide would be greatly appreciated. I have done a tremendous amt of research on this and all the research says there is a correlation, however, I have heard mixed theories. I would also like to know your advice on treatment for a subsequent pregnancy if one had suffered a late term loss (lost 10 lb. baby girl at 38 weeks gestation.) I am finding there is also a very gray area on this topic. I have never suffered any medical problems. I am active and healthy. A: Most studies confirm an association between thrombophilia (increased incidence of blood clotting such as seen with Factor V Leiden) and both early and late miscarriages. As mentioned above, our expert would recommend treatment with the blood thinner Lovenox 40 mg by injection daily throughout pregnancy and for 2-3 months after delivery.