Lovanox/Heparin and delivery

emmalil

Others who are on blood thinners -- what have your OBs, hematologists, etc. told you about planning for birth?  Definitely an induction?  At what point in pregnancy? 

My hematologist said she would be comfortable with taking me off the blood thinners and 39 weeks to let the baby come when it was ready, but the OB said no way and I was just curious what others of you have been told? 

bmk112302

I had an induction at 37 weeks. I was on Lovenox the entire time. My Lovenox was stopped 2 days prior to the induction.

bjmyangel

I am on Lovenox.  Will be switched to Heparin at 36 weeks.  My MFM is suggesting a planned induction around 38 weeks.  My OB is just waiting to communicate directly with MFM so they can decide together what will be best.  Right now, it sounds like I will be induced early in week 38.  Heparin will be stopped 24 hours prior to induction from what my understanding is right now.

emmalil

ETA: Thanks for sharing your experiences!

My understanding is that Lovenox is a particular form of low molecular weight heparin -- when you say they switch you to Heparin, what does that mean?  And what reason did they give you for the switch?

bmk112302

Lovenox is one shot a day and it stays in your system much longer than the Heparin. Heparin is 2 shots a day.  I was never switched last time. This time I'm taking Heparin instead of Lovenox due to some insurance issues. I hope to be back on the once a day Lovenox soon.

Anna&Matt

I was switched to heparin at 36 weeks and will deliver via c/s ( for other medical reasons) at 39 weeks. They switched me in case baby decides to come earlier as heparin has a shorter life span than lovenox. If I had no other issues they would let me deliver on my own or induce at 41 weeks.

bjmyangel

I am on Lovenox and I take 2 injections daily.  (I am on a high dose.)  The lovenox stays in your system longer.  I am being switched to heparin at 36 weeks because it does not stay in your system as long as the lovenox does.  I don't know how many injections I will have to take of heparin daily.  Here's what my MFM said as far as why I need to be induced...if I do not plan an induction (or if I go into labor before my induction date) I run a higher risk of hemorrhage because I will not know when to stop the heparin injections.  Also, since I want (ok...NEED) an epidural...because I'm not a fan of pain...it will not be an option if I have not been of of the heparin long enough.  I am not willing to take those risks, so I am going to be induced around 38 weeks.  If I show signs of labor before then, they may test the baby's lungs for maturity and induce me earlier than 38 weeks.  No matter what, I have to be off of the heparin long enough before labor so that my risk of hemorrhage is lower and I can have my epidural.  Hope this info helps.

Mrs.Butter

bjmyangel:

Here's what my MFM said as far as why I need to be induced...if I do not plan an induction (or if I go into labor before my induction date) I run a higher risk of hemorrhage because I will not know when to stop the heparin injections. 

I'm the same as you - Lovenox, switching to Heparin at 36 weeks.  Except that my doctors said I could labor naturally and get an epidural because they have an antidote for Heparin.  If you want to avoid an induction, maybe you could ask about the antidote?  I'm trying to avoid an induction prior to 41 weeks because of the higher risk of complications / c-sections (and I already have a clotting disorder and want to avoid complications from c-section such as pulmonary embolism)...

MrsMSG

I will stop my Lovenox a 35w, and switch to Heparin for a week, and then have a c-section at 36 weeks.

LuvnlifeinCO

With DD I was on lovenox once a day until induced at 39 wks - no epi allowed.  When I delivered the placenta abrupted and there was a lot of blood.  She ended up in NICU for a couple hours and think here growth had slowed significantly the last couple wks of pg due to clots in the cord.  Trying to avoid that this time. This time I'll also be on lovenox twice a day until the end - no epi allowed and induced around 38 wks depending on what perintologist says (next appt this Thurs). 

aglenn

I was on Lovenox, switched to heparin around week 36 or 37 I think (I can't believe I'm forgetting the details already!), went into labor on my own and delivered just 4 days before my due date.  Labor was, ahem, LONG for me, so I had plenty of time between my last injection and epidural time.  My doctor doesn't induce just because of heparin.

For the pp, yes, Lovenox is a form of heparin but it's different in some way and stays in the system longer than plain old heparin, hence the switch.  I'm no pharmacist so I can't explain exactly why, but that's what my docs told me.

trickywoo

I was on lovenox with my last pregnancy.  I was on 40 mg lovenox + baby aspirin in the first two trimesters.  Then they upped me to 80 mg lovenox in the last tri.

 At about 36-37 weeks I stopped the baby aspirin, and I was induced at 37.5 weeks.  I took my last lovenox shot 24 hours before the induction.  After I delivered I was back on lovenox again.

 My OB doesn't like switching to heparin because it's harder to manage.  So it means a set induction.  I was really nervous about it, but had a super positive experience, so I'll do the same thing this time.  Good luck!

trickywoo

P.S.  Many OBs switch to heparin because you can have an epidural while on heparin and there is an antidote if you were to go into premature labor that can very quickly remove the effects of heparin.  Also, you can stay on heparin and just go into labor naturally, while, if you're on lovenox you need a more controlled delivery.

Lovenox has a half life of 12 hours, which is why you really need to be off of it for 24 hours before receiving an epidural.  There have been some causal links between epidural and problems with lovenox (although typically this is with an extended epidural)

 So, really, the risk of staying on lovenox and not being induced is that you wouldn't be able to have an epidural and would need general anesthesia if you had to have an emergency c-section.

But, if you are induced, you can just go off the lovenox in enough time.

 Does that make sense?