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Re: Coumadin and pregnancy From: John Robertson MD (john.robertson@obgyn.net) Fri Jan 14 15:59:05 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Betsy Hyde: "LWM heparin" Previous message: Marinus van der Ploeg, MD: "Labor induction in fetal death and placenta praevia" In reply to: Jerry R. Rowe MD: "Coumadin and pregnancy" At Fri, 14 Jan 2000, DoctorJoe@aol.com wrote: snip > >Standard recommendations: > >1. Coumadin is relatively contraindicated in the 1st trimester due to >congenital anomalies, and near term, due to possible fetal hemorrhage. > >2. With a mitral valve replacement coexistent with pregnancy, there should be >little cardiac problem if the heart is otherwise normal. If there is residual >insufficiency or stenosis, then that needs to be considered. On the other >hand, in someone with a congenital heart defect, HER BABY has about a 3% >chance of cardiac anomalies, the same as any polygenic defect. > >3. Heparin can be used in pregnancy. > >The "standard" strategy for handling pregnant women in need of >anticoagulation is to use heparin in early pregnancy, say until about 12-14 >weeks, and then switch back to coumadin until a few weeks before delivery. >Then switch to heparin peripartally, then back to coumadin postpartally. Of >course, there are lots of variations as to how to do this. > >Joe P. If cost was not the issue I would go with LMW heparin for the entire pregnancy - appears to be the safest. Would be uncomfortable with using coumadin in pregnancy at any stage but that may just be my bias - other opinions? John -- J.G.M.Robertson MD, 109-9181 Main St. Chilliwack, B.C. V2P 4M9 (604) 793-9988 e-mail john.robertson@obgyn.net Who is wise and understanding among you? Let him show it by his good life, by deeds done in the humility that comes from wisdom. James 3 vs 13, NIV Next message: Betsy Hyde: "LWM heparin" Previous message: Marinus van der Ploeg, MD: "Labor induction in fetal death and placenta praevia" In reply to: Jerry R. Rowe MD: "Coumadin and pregnancy"

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