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:
