Since I'm making this blog public again, it's time for an update. I want to post a few things about my last pregnancy (2nd one on lovenox).
There were many
similarities to my 1st lovenox pregnancy. Namely, the
anti-coagulant protocol was the same (daily shot of 40 ml lovenox from confirmation of pregnancy until switched to heparin 2x/day shots near delivery + 81mg aspirin until 35 wks.) I had
subchorionic hemorrhages (aka SCHs) in both pregnancies that thankfully resolved themselves eventually. Also, there was still a lot of monitoring of the pregnancy including
weekly bio-physical profiles in the 3rd trimester. Just like last time, baby was malpositioned, likely due to my large (12 cm)
uterine fibroid. Thankfully, this baby followed her sister's example and turned on her own just before the scheduled external cephalic version, so I was able to be induced and deliver vaginally. It was a wonderful birth.
We are so lucky to have our little miracles.
Some differences:
1- My
MFM moved out of state. The new one was kind and competent, but definitely had a different approach to FVL. He told me at the 1st consultation that he generally subscribes to the ACOG's recommendation that only women with prior clots be treated with injectable bloodthinners in pregnancy.
I strongly advocated for treatment with lovenox. (I have a law degree and am emotionally invested, so you can use your imagination here on how difficult I was to convince that my history of recurrent pregnancy loss does not indicate treatment!) When I started citing studies on RPL and genetic thrombophilias, he realized that I was an educated patient and had good reasons not to follow ACOG's recommendations.
2- In part because of the change in MFM and partly because of a lab mix up my first time on lovenox, my
anti-factor Xa levels were not checked this pregnancy. We just assumed the dose was adequate last time and continued with that. But in retrospect, perhaps I should have insisted on that again because there was was evidence that it wasn't optimal.
3- The baby's growth slowed significantly as we approached term. Her estimated weight was only in the 10%. (She had measured 50% earlier-- perfectly normal). Her femur length was still average, but her abdominal circumference was only 2.3 percentile. These measurement qualified as Intrauterine Growth Restriction (
IUGR). The asymmetrically small abdomen can indicate placental insufficiency. Indeed, when I delivered the OB commented on how small her placenta was. I haven't found any studies linking clotting with a
small placenta, but I have read some speculation on this.
Thankfully, she has been busy catching up on her growth since birth.
She is a joy and we are thankful we decided to try again.
She weighed 5lb11oz at birth.
25 percentile for weight at 2 months. She is sweet, healthy & happy.
There were many similarities to my 1st lovenox pregnancy. Namely, the anti-coagulant protocol was the same (daily shot of 40 ml lovenox from confirmation of pregnancy until switched to heparin 2x/day shots near delivery + 81mg aspirin until 35 wks.) I had subchorionic hemorrhages (aka SCHs) in both pregnancies that thankfully resolved themselves eventually. Also, there was still a lot of monitoring of the pregnancy including weekly bio-physical profiles in the 3rd trimester. Just like last time, baby was malpositioned, likely due to my large (12 cm) uterine fibroid. Thankfully, this baby followed her sister's example and turned on her own just before the scheduled external cephalic version, so I was able to be induced and deliver vaginally. It was a wonderful birth. We are so lucky to have our little miracles.
Some differences:
1- My MFM moved out of state. The new one was kind and competent, but definitely had a different approach to FVL. He told me at the 1st consultation that he generally subscribes to the ACOG's recommendation that only women with prior clots be treated with injectable bloodthinners in pregnancy. I strongly advocated for treatment with lovenox. (I have a law degree and am emotionally invested, so you can use your imagination here on how difficult I was to convince that my history of recurrent pregnancy loss does not indicate treatment!) When I started citing studies on RPL and genetic thrombophilias, he realized that I was an educated patient and had good reasons not to follow ACOG's recommendations.
2- In part because of the change in MFM and partly because of a lab mix up my first time on lovenox, my anti-factor Xa levels were not checked this pregnancy. We just assumed the dose was adequate last time and continued with that. But in retrospect, perhaps I should have insisted on that again because there was was evidence that it wasn't optimal.
3- The baby's growth slowed significantly as we approached term. Her estimated weight was only in the 10%. (She had measured 50% earlier-- perfectly normal). Her femur length was still average, but her abdominal circumference was only 2.3 percentile. These measurement qualified as Intrauterine Growth Restriction (IUGR). The asymmetrically small abdomen can indicate placental insufficiency. Indeed, when I delivered the OB commented on how small her placenta was. I haven't found any studies linking clotting with a small placenta, but I have read some speculation on this.
Thankfully, she has been busy catching up on her growth since birth.
She is a joy and we are thankful we decided to try again.
She weighed 5lb11oz at birth.
25 percentile for weight at 2 months. She is sweet, healthy & happy.