WOMENS-HEALTH Messages for February, 2001: Re: miscarriages and APAs and timing of heparin

Re: miscarriages and APAs and timing of heparin

From: Lynn D. Montgomery, MD (anonymous@obgyn.net)
Wed, 28 Feb 2001 17:20:03 -0600 (CST)

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In reply to: nancy: "miscarriages and APAs and timing of heparin"

At Wed, 28 Feb 2001, nancy wrote: >
>Hello,
>Do any of the Dr.s know what the most likely time of miscarriage is in
>people with one or more positive APAs? I read somewhere that it is
>usually (86%)after fetal heart activity has been detected, while in the
>general population half the miscarriages occur before fetal heart
>activity. If so, what does that mean? Is it safe to wait until heart
>activity is seen before starting the heparin therapy?
>
>I am 39, have some positive APAs, & hx of 2 early miscarriages, (one
>choromosomally abnormal), and thank God, one healthy son (while taking
>asa, heparin,progesterone, and an estrogen patch - the kitchen sink!).
>My 4th pregnancy seems to be nonviable at almost 7 wks and my ACA is
>positive at 12, with upper nl being 10. I did not do the heparin, only
>the asa and progesterone. Was that a mistake and cause of this
>miscarriage??? It is just too hard to take heparin every month you're
>trying to get pregnant.
>
>Thanks! Nancy

Nancy, With only pregnancy loss in your history, especially when one of your two was associated with abnormal chromosomes, I would question whether heparin is really an issue at all. First, to be significant, both the IgG and IgM's of either the anticardiolipin or lupus anticoagulant should be positive. One immunoglobin without the other is not significant. Further, unless there is a history of other vascular abnormalities, such as embolus, heparin isn't really indicated either. My recommendation would be for low-dose aspirin (81 mg)beginning at the time of pregnancy diagnosis and continuing though 36 weeks gestation... Lynn

--
Lynn D. Montgomery, MD
Director, Maternal-Fetal Medicine
Rocky Mountain Perinatal Center
Missoula, Montana

**Note:  Opinions expressed here are for educational purposes only and, as such, do not constitute a physician-patient relationship.  This information is not intended to supplant the need for you to consult with your physician prior to choosing therapeutic options and/or interventions.

**Private e-mails cannot be entertained due to time constraints, consequently no private e-mails will receive a response.

**Thank you for your understanding ;-)

Next message: Lynn D. Montgomery, MD: "Re: cervical bleeding"
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In reply to: nancy: "miscarriages and APAs and timing of heparin"

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