If you have been prescribed a treatment dose of blood thinning injections because you have been told that you have or may have a blood clot, here is some important information for you.Also read:
If you think labour has started or your waters have broken or you experience vaginal bleeding
Do not take further blood thinning injections and contact your maternity unit to arrange a review.Aim for vaginal birth on labour ward with spontaneous onset of labour.
If the birth is planned as an elective caesarean section
Stop taking blood thinning injections 24 hours prior to admission for induction of labour. On admission, tell the midwife the time you took your last injection.
In labour
All efforts will be made to reduce the time interval that you are without blood thinning injections, to help keep your blood clot risk low. On admission, inform the midwife the time you took your last injection.You will have medical and anaesthetic involvement during labour and induction of labour.Active management of the third stage of labour is recommended. For more information read:
If postpartum haemorrhage (PPH) occurs, this will be managed by senior members of the maternity team
If you are considering an epidural in labour
The safe time interval between blood thinning injections and having an epidural is at least 24 hours. This is to minimise the risk of bleeding. Inform staff the time of your last injection.
After the birth
The dose will be restarted as soon as possible after the birth and will depend on your risk of bleeding.
Duration of treatment after the birth
Treatment must continue for at least 6 weeks after the birth as the risk of blood clot is highest after the birth. The total duration will depend on when the treatment was started in pregnancy and must be at least 3 months. The maternity team will discuss the medication options before you go home.Switching to an oral anti-coagulation medication can be considered but this should be 5 days or more after birth. However direct oral anticoagulation medication is only an option if bottle feeding.Warfarin and LMWH are safe with breastfeeding.
Follow up after hospital discharge
A clinic appointment with a specialist doctor will be arranged to provide you with guidance for the future, including the next pregnancy.
Decide family planning method
Progesterone Only Pill (POP)/Implant/Intrauterine device/other. See here for more information:
If you have been told that you have a high chance of developing a blood clot during pregnancy and have been prescribed a PREVENTION dose of blood thinning injections, here is some important information for you.Also read:
If you think labour has started or your waters have broken or you experience vaginal bleeding
Do not take further blood thinning injections and make contact with your maternity team to arrange a review). Aim for vaginal birth on the labour ward with spontaneous onset of labour.
If the birth is planned as an elective caesarean section
Stop taking blood thinning injections 12 hours prior to planned operation date (so the last dose should be at around 18.00 on the night before admission).
If you require induction of labour
Stop taking blood thinning injections 12 hours prior to admission for induction of labour (so the last dose would be around 18.00 on the night before admission). On admission, tell the midwife the time you took your last injection.
In labour
All efforts will be made to reduce the time that you are without blood thinning injections, to help keep your blood clot risk low. For the delivery of the placenta. active management is recommended. See here for more information:
If postpartum haemorrhage (PPH) occurs, this will be managed promptly by senior members of the maternity team.
If you are considering an epidural in labour
The safe time interval between blood thinning injections and having an epidural is at least 12 hours. This this is to minimise the risk of bleeding.
After the birth
The injections will be restarted as soon as possible after the birth and will depend on your risk of bleeding.
Duration of medication after the birth
Blood thinning injections must continue for at least 6 weeks after the birth as the chance of developing a blood clot is highest after the birth. Warfarin and LMWH are safe with breastfeeding. Switching to an oral medication may be considered after 5 days after the birth. However, direct oral anticoagulant therapy is only an option if you are bottle feeding your baby.
Decide family planning method
Progesterone Only Pill (POP)/Implant/Intrauterine device/other. See here for more information:
Deep vein thrombosis (DVT) in pregnancy: Frequently asked questions
How is the diagnosis made?
At your initial appointment with the midwife, periodically through the pregnancy and after your baby is born you will be risk assessed for your personal chance of developing a venous thromboembolism (DVT). All women will be recommended to keep hydrated and mobile during pregnancy, labour and birth. Those in groups with a medium to high chance of developing a DVT may have additional care recommended to them.Interventions during labour and birth, such as assisted vaginal birth or caesarean birth increase your chances of developing DVT.
What does this mean?
For Me
Women who have a higher chance of developing DVT during pregnancy may be recommended to take a medication during pregnancy and the postnatal period to reduce this chance. The medication is a daily injection of a blood thinning medication (low molecular weight heparin) which you will be taught how to administer to yourself. Your partner or family member can be taught how to give the injection to you if you prefer.In addition you may be given compression stockings, to wear when you are admitted to hospital.
For my baby
The low molecular weight heparin injections do not cross the placenta and your baby will not be affected by their use.
What symptoms and signs should I be looking out for?
If you develop any swelling or pain in your legs or chest pain or difficulty in breathing you should attend the maternity unit for review as soon as possible.
How may this impact my birth choices?
If you are taking a preventative dose of low molecular weight heparin during pregnancy, there needs to be a 12 hour window between your last injection and the siting of an epidural (pain relief). So if your labour is starting or your waters have broken and a dose of the medication is due, please speak to your midwife or obstetrician first.
How may this affect care after the birth?
Women who are at a higher chance of developing a DVT might be recommended to have low molecular weight injections for ten days or six weeks after their baby is born.
What will this mean for future pregnancies? How can I reduce my risk of this happening again?
Depending on the reasons you have an increased chance of DVT, these reasons are likely to occur in any future pregnancy.
Where can I find out more information about this condition?
