Hema vs Peri/MFM vs OB - Still feeling crappy

megwv3 · June 2014

If anyone has seen my other post, this is a bit of an update.

I'm 24 weeks pregnant. I had 3 first trimester miscarriages. I have hetero Factor V Leiden with no history of clots. However, I'm on baby aspirin that I started at 4w. The dilemma was the perinatal center at the hospital I go to only uses baby aspirin to treat patients like me. I went to see a hematologist for a second opinion. He said 30mg of Lovenox and wrote a letter to Peri. I met with the Peri/MFM and he was very adamant on just using baby aspirin. He said my chance of clotting is 1% more than the general population and there's no correlation between what I have and stillbirth. I told him I'm only concerned about placenta/cord clots and he said that the baby aspirin is enough for that as it crosses the placenta. He doesn't think I'm at a great risk for a clot so he doesn't want to use Lovenox.

I spoke with my OB about all of this and she would back whatever I want to do. However, she agreed that the baby aspirin is sufficient. I asked about other clotting factors and she wanted to give me two more tests that weren't in my thrombophilia panel. An ANA test (Antinuclear Antibodies) and a fasting homo cystine level. She said if anything came back abnormal, then maybe the Lovenox would be a better idea.

I'm just so confused and frustrated. I want to do what's best for my daughter and that's all. I did have a very bad bleed at 12w that was unexplained (possible hematoma) and I do bruise easily. Normally I'd say well if hematology wants the blood thinner, why not? But the Perinatal center won't treat me for it as they believe that the "benefits" aren't substantially beneficial. It is a low dose and it is for my blood, not hers.

I just needed to vent because this whole thing makes me cry. I want to see a therapist or something.

melsod · June 2014

I don't have any advice for you but wanted you to know that someone read your post & was thinking about you. It's a difficult spot that you're in when you're not sure which specialist to listen to. Good luck with everything.

kflynn81 · June 2014

***Lurker****

Our situation is a little different as we unfortunately lost our son due to severe preeclampsia as 20 weeks, but I also am heterozygous for FVL and have been on Lovenox on and off during infertility treatment cycles for a few years. I've had a few superficial clots as well which may make a difference in my care management of it. However, when I got pregnant last summer , my hematologist claimed that I probably didn't need the Lovenox either but said it wasn't harmful to take it as a precaution if anything else so I did take it. I had taken a baby aspirin with my fertility treatment up until 10 weeks but this time around I'll be on both the whole pregnancy.

I'm not sure if that helps at all but I hope it does a little!!

Ylvelill · June 2014

I would consider seeing a different perinatologist just for a second opinion.

PrincessBritt17 · June 2014

I agree that you should get another opinion. We had severe pre-e with our daughter and she was born at 30w6d. We found out that I am hetero for the Prothrombin mutation and we consulted with multiple perinatologists before getting pregnant and also again during the pregnancy to make sure that we were comfortable with the plan. I am currently on Lovenox, baby aspirin, fish oil, vitamin D, and progesterone suppositories (cervical shortening). It seems like a lot and everyone has agreed that it may or may not help, but I am willing to try anything to avoid the situation we were in last time. We are now 30w and I am still feeling good (knock on wood)! If you are not comfortable with your care you will have increased stress, which will not help your situation. See if you can find another perinatologist to consult with and see if you can get more answers. Good luck!

megwv3 · June 2014

That's the only Perinatal center in the AREA. They have 12+ doctors and are the best in the state, the only one my insurance covers.

Mrs.McIrish · June 2014

Will your OB prescribe it despite her feeling that it isn't necessary? I'm on lovenox and baby aspirin for homozygous MTHFR and my MFM said I didn't t really need either. But he won't fight me on it as I want to stay on it. It was the only thing we did different this cycle (8 rounds of IVF) so I won't go off it even if its all in my head.

megwv3 · June 2014

No, because the Perinatal are that adamant about not treating it. They could drop me as a patient and I know I need to go because they check blood flow from placenta/cord at 28w and 34w. However, I have hetero so your MFM would probably be even more adamant with me lol. Both of mine said for homo they would treat.

Manada · June 2014

I don't have advice as I am unfamiliar with clotting disorders, but I just want to say from one person who is terrified and traumatized in this pregnancy to another that I am thinking of you and hope that you find some clarity soon.

Disagreements between doctors is the worst, Our main MFM treats us as very high-risk, and orders lots of monitoring and is conservative with relaxing it, while the other one we have seen lately is much more laissez-faire about the whole thing --- it just stresses me out!

Good luck. I agree a 2nd opinion sounds like its in order. Clots are scary. Have you talked to your Peri about what the risks of lovenox are and how they are balancing that?

megwv3 · June 2014

Peri doesn't want Lovenox because there are no indications that FVL affects me, especially being hetero. It would be like giving someone Tylenol to prevent a headache that didn't happen, in his opinion. I was underweight when I became pregnant. Never had a clot. My mom has never had a clot and had two healthy pregnancies. He doesn't believe my miscarriages were from FVL but either low progesterone or bad eggs. FVL can affect 2nd/3rd but him as well as my RE does not believe first trimester. Also, my scans have been clear. They do a blood flow test every visit that measures flow. Also, Lovenox is for me while aspirin is for baby. He thinks aspirin is enough.

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Hema vs Peri/MFM vs OB - Still feeling crappy

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