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Re: CVA prior to pregnancy. From: ainsron (ainsron@sbcglobal.net) Sat Oct 14 10:53:14 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: art fougner, md: "Re: 'How childbirth went industrial'" Previous message: ainsron: "Re: Prophylactic MgSO4" In reply to: Andrew Folley: "Re: CVA prior to pregnancy." Next in thread: zygote@icsi.net: "Re: CVA prior to pregnancy." They felt it was thrombotic, MRA showed a significant stenosis of the right internal carotid artery. No evidence of thrombophilia. Ronald E. Ainsworth, MD, FACOG -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Andrew Folley Sent: Saturday, October 14, 2006 5:59 AM To: Multiple recipients of list OB-GYN-L Subject: Re: CVA prior to pregnancy. Any idea what the etiology was behind the CVA? Hemorrhagic or thromotic? Underlying thrombophilia? Phospholipid antibodies? HbA1 of 10 places her at extreme high risk for first trimester developmental anomalies I believe on the order of 10-20% Theraputic lovenox bid until 38 weeks and follow the Factor Xa levels to make sure theraputic. C-section at 38 weeks (plus or minus amnio) stop lovenox 24 hours ahead of time or switch ot hemparin at 36 weeks. Start coumadin post op and Continue heparinzation until coumadin PT levels or INR back in theraputic range. The way she is going, expect placenta previa with percreta and be prepared for C-hyst. consider being prepared to embolize at time of section.??? Just some clinical thoughts. >From: ainsron@sbcglobal.net (Dr. Ainsworth) >Reply-To: ob-gyn-l@obgyn.net >To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> >Subject: CVA prior to pregnancy. >Date: Fri, 13 Oct 2006 21:20:13 -0500 > >I've recently acquired a NOB who had a CVA 2 1/2 months ago, she is >currently 9wks pregnant and has residual left hemiparesis. She had been >on coumadin, but her PCP changed her to Lovenox when the pregnancy was >diagnosed two years ago. She is a type 2 diabetic, now on insulin since >her CVA, her Hgb A1c in July was over 10, and hasn't been tested again >since that time. She was on an ACE inhibitor and ASA which her PCP also >discontinued. She is also AMA, 3 previous C/S and the list goes on and >on. The obvious concern I have is her risk of recurrent CVA during this >pregnancy. Does anyone have any astute advice or literature references >that address this? I am scheduling her for a perinatal consult, sweet >success program to assist with DM management and will discuss durable >power of attorney with her (not TIC). She is not interested in >termination of the pregnancy and says she understands the risk the >pregnancy poses for her own health and life. I like challenges, but >this could be hairy! > Next message: art fougner, md: "Re: 'How childbirth went industrial'" Previous message: ainsron: "Re: Prophylactic MgSO4" In reply to: Andrew Folley: "Re: CVA prior to pregnancy." Next in thread: zygote@icsi.net: "Re: CVA prior to pregnancy."

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