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Pregnant, US showed low lying posterior. History of miscarriage. Was positive for APTT and APLA, started Heparin

Mar 2016
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Answered by

Practicing since : 2011
Answered : 4045 Questions
I am 29 yr old and pregnent with 20 weeks now had last weak ultrasound and found low lying posterior ultrasound. With this I had an bad history of miscarriage last 2 times. 1st was on 28-29 weeks in yr 2011 and 2nd was on 26-27 weeks in yr 2012. This time when I gone thrw with all my examinations and test before prignancy I was +ve with APTT and APLA test so my Dr. Started low molecular heparin (Exhep 60 mg, SC) daily from 11 th week still its continued. I am very upset about this complications last two times......and now i found this problem of Low Lying placenta posterior. Please tell me about the future precautions as my doctor is doing PTINR test in frequent interwal for doses of heparin now this reading for PTINR is PT -16.1 and INR-1.34 RATIO . Kindly help me for these kind of complications.......???
Posted Sat, 28 Sep 2013 in Women's Health
Answered by Dr. S Patra 1 hour later
Brief Answer:
Don't be afraid. Follow the suggestive measures.

Detailed Answer:

Thanks for writing to us on Healthcare Magic.

I am so sorry to hear about two consecutive pregnancy loss at the beginning of 3rd trimester. The cause of previous recurrent miscarriage was possibly Anti Phospholipid Antibody (APLA). Now, it should be treated properly in the current pregnancy to avoid pregnancy loss. Here, I have two comments regarding your query:

1) Low lying placenta is seen in some percentage of women at 16 to 20 weeks through ultrasound scan. It is less complicated at this stage but you need to be careful about this to avoid future risks.

It is seen that over the time (during 3rd trimester), as uterus is enlarged, the lower part of the uterus also grows and stretches, taking the placenta with it to move upwards in most of the cases. Though, in 0.5% of cases, the placenta doesn’t move up with the uterus and antepartum hemorrhage (like placenta previa) may develop in late 3rd trimester with related risk to baby.

Here, complete monitoring is mandatory. Therefore, I suggest you to undergo next ultrasound scan after 26 weeks to check the placental status. If there is same picture, you will most probably be put on bed rest.Then you will have to do another ultrasound after 32 weeks to see if the placenta has moved away from the os.

You need to consult with your obstetrician for proper management if any type of complication arises. Urgent caesarean section may need to carry out for saving the baby after 34 weeks if placenta previa develops as end result.

2) For positive APLA, you need to continue subcutaneous low molecular weight heparin (LMWH). It is quite safe in pregnancy. However, your last test results are not so good. Normal PT is 12- 14 sec and INR is 2-3.

INR less than 2 has always increased risk of thrombosis as well as growing fetus. Kindly, consult with your gynecologist to increase or adjust the current dose to get effective result and better outcome.

In addition, you should follow some basic steps for healthy pregnancy like:

1) Continue to take iron, calcium and other vitamin supplements. Complete all necessary investigations.
2) Take healthy protein XXXXXXX diet (350 Kcal/ day) with more green vegetables and fresh fruits.
3) Drink plenty of water to stay hydrated and for better feto-placental circulation. Keep bowel habit regular.
4) Take adequate bed rest, avoid heavy work/ journey with bikes/ high heal shoe/ uneven surface etc.
5) Maintain genital hygiene properly and avoid sexual intercourse which may precipitate bleeding episode.

Hope, above information is quite helpful to you. Let me know, if you need any further clarification.

Wish your good health & successful motherhood.

Dr Soumen
Above answer was peer-reviewed by
Follow-up: Pregnant, US showed low lying posterior. History of miscarriage. Was positive for APTT and APLA, started Heparin 8 hours later
Dear sir
Thank you so much for your valuable suggestion and advice....!!
Sir I want to know about the food/fruit products and habit to get increase better blood circulation to my baby and decrease tinny blood clots in of now I am taking XXXXXXX pomegranate, peach...and also I want to know that is Banana is a good fruit to increase blood circulation and to decrease blood clots as it contain phosphate....??
Sir as of now in madication I am taking Exhep 60mg (LMWH) in morning with alphadopa 250 mg twice a day, Ecosprin 75 mg daily in night and with IRON, CALCIUM, FOLICACID capsule with dupastone this a better medication or i have to increse the dose of LMWH at this time of my PTINR value is getting increase month on month as i have completed 2 month doses of LMWH and since last 3 months PT plasma IS Increasing by....13.4, 14.8, 16.1 (chronic order) and INR ratio is 1.02, 1.14, 1.34 and Mean Normal PT is 13.1, 13.4, 12.3 month on this can we understand risk of cloting thombossis in blood .....???
This point of time in prignancy should I go with again APTT & APLA.....or PT-INR is sufficient enough......can I go for 3D coloured ultrasound to see the better clotings in placenta or vessels if its possible......please suggest the best posible way......??
Here I am attaching the previous reports for APTT & APLA WITH PTINR....
Password to open attachment is " G0167 "
Answered by Dr. S Patra 6 hours later
Brief Answer:
Follow the sugestive measures.

Detailed Answer:

Thanks for your follow up queries.

Very sorry to say, not a single attached image is readable. However, it is a technical problem during the scanning process.

Followings are my comments regarding your query:

1) Salicylate, omega-3 fatty acid and vitamin E or other anti-oxidants enriched food stuffs are useful at this stage of pregnancy to prevent blood clots.

Salicylates: It is found in curry, cayenne, paprika, turmeric, ginger, licorice and peppermint. Fruits include strawberries, blueberries, cranberries, grapes, raisins, oranges, prunes etc.

You can take 1-2 glass fruit juice daily from your favourite fruits, mentioned above. It will help for better systemic circulation and prevents developing tiny clots. I would not recommend banana in comparison to above fruits.

Omega-3 fatty acid: It is found in anchovies, salmon, lake trout, herring and mackerel. Fish oil is a good source. Plant based subs are sunflower seeds, canola oil, corn oil, safflower oil and soy.

Vitamin-E: It is found in walnuts, almonds, canola oil, sunflower oil and palm oil; and in lentils such as chickpeas, oats and wheat.

In addition, you must AVOID vitamin K XXXXXXX foods (coagulation prone) green leafy vegetables such as XXXXXXX spinach, broccoli, lettuce, asparagus and some fruits, such as peaches and bananas.

2) Above mentioned medications are essential for healthy pregnancy and needs to be continued as per your doctor's direction.

Normal INR is 2-3 but you have results with less than 2 which indicates risk of developing clot or thrombus. In my opinion, dose of LMWH is to be increased until it reaches up to INR 2. Serial monitoring of PT & INR is recommended for proper understanding of clotting risk or thrombosis. Kindly, consult with your gynecologist regarding this.

3) You do not need to repeat the tests for APTT & APLA as you had undergone those previously. PT-INR is sufficient for monitoring & dosing of LMWH.

I recommend to undergo Color or Duplex doppler ultrasound scan to get detailed picture on blood vessels including placenta. 3D scan is not so useful in this purpose.

Hope, I have guided you with my experience. If you don't have any other query, you can close the discussion.

All the best. Good luck.

Dr Soumen
Above answer was peer-reviewed by
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