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Re: Placental thrombosis From: JD Stewart,MD (jdstewartmfmob@sbcglobal.net) Wed Nov 1 12:54:52 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Andrew Folley: "Re: early onset severe IUGR and ambiguous genitalia without any other anomaly" Previous message: JD Stewart,MD: "Re: early onset severe IUGR and ambiguous genitalia without any other anomaly" Next in thread: Efrain Ramirez: "Re: Placental thrombosis" Reply: Efrain Ramirez: "Re: Placental thrombosis" Unless the bedrest is for spotting and bleeding... Given her history, LMW heparin might be a good option...might consider a lower dose recipe ...and the Anesthesiologists might want her off this for 2-3 days prior to epidural/spinal , particularly if testing is not readily available. One group here in town is insistent on this, others less so. At Mon, 30 Oct 2006, Efrain Ramirez wrote: > >Would you consider enoxaparin instead? > >Ef > >>At Mon, 30 Oct 2006, JD Stewart,MD wrote: >> >>Likely if they discovered the MTHFR heterozygous status, the >>FVLeyden/Prothrombin/PA1 markers have been run as well. Possibly the >>autoimmune SLE/AclAb/ Beta 2 Gly panel should be run, too if it hasn't. >>If it was equivocal, rerunning the titers may be helpful as far as >>pushing towards more aggressive anticoagulation. >> >>If she is positive for another marker, or IUGR as yet, moving to SQ >>prophylactic heparin may be a reasonable step. >> >>Adding ASA QD shouldn't hurt either. >> >>I'm curious as to why a thrombophilic pregnant woman is on bedrest...is >>there a hypertension problem? An aerobics instructor problem? Compliance >>problem? >> >>At any rate, she is certainly at a risk to deliver early- consider >>steroids at whatever recipe you are fond of... >> >>At Sat, 28 Oct 2006, Andrew Folley wrote: >>> >>>Any thoughts on a G5P1A3 with 1 living child and 2 miscarriages and a >>>history of 16 week prior fetal demise admit with "placental thrombosis". >>>Patient with dx of thrombophilia based on MTHFR heterozygous status. Echo >>>showed thickend placenta 5 cm at 31 weeks. Dopplers normal but some >>>"notching" of the uterine artery. Plan bedrest and folic acid b12 till term >>>per MFMs. >>>Any experiecne with this???? >> >>-- >>JD. Stewart, MD >>MFM up too late all night, every night >> >-- >“ The greatest obstacle to knowledge is not ignorance, >it is the illusion of knowledge.” Daniel J. Boorstin - Historian > -- JD. Stewart, MD MFM up too late all night, every night Next message: Andrew Folley: "Re: early onset severe IUGR and ambiguous genitalia without any other anomaly" Previous message: JD Stewart,MD: "Re: early onset severe IUGR and ambiguous genitalia without any other anomaly" Next in thread: Efrain Ramirez: "Re: Placental thrombosis" Reply: Efrain Ramirez: "Re: Placental thrombosis"

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