10 October 2014

My Wife is Pregnant Again!

Just now she showed me the test strip and there were two lines; two means pregnant and one means not pregnant. So just nice, we are going to her home at the end of this month on 31 Oct so we can also see her doctor and listen to what he say.

My wife's last period started on 08 Sep, that means now she is in her 5th week of pregnancy. I calculated using this tool.

Anyway I was worried about my wife taking Warfarin while she is pregnant, according to my research online, I found that Warfarin is not good for the baby between the 6th and 9th weeks of pregnancy, and the alternative such as Heparin is less effective than Warfarin, basically Warfarin is the best anticoagulant for patients. Luckily I found this article and this which gave me some relief, reason being that my wife's dosage is 3.5mg per day, quoted from the article:

"According to our experience the untoward effects of warfarin are dose-dependent [3]."

"In our study 43 pregnant patients with mechanical valve prostheses were kept on warfarin continuously until the 38th week of gestation when a cesarean section was planned after warfarin administration had been stopped for 2 days."

My wife has a mechanical heart valve, I quote more:

"In detail in the group of 33 gestations, with patients taking a warfarin dose ≤5 mg, there were 28 healthy babies and only five fetal complications (four spontaneous abortion and one fetal growth retardation). In the other group of 25 gestations, with patients taking a warfarin dose >5 mg, three full-term pregnancies and 22 fetal complications (18 spontaneous abortions, one stillbirth, one ventricular septal defect and two warfarin embriopathies) were observed."

What this tells me is that patients with higher Warfarin dosage will have higher chance of fetal complications. Let's see more:

"Those patients whose warfarin intake is ≤5 mg with an international normalized ratio (INR) within therapeutic range may continue to take warfarin during the entire pregnancy under strict medical surveillance, and consider a programmed cesarean section at the 38th week of gestation while briefly interrupting warfarin therapy. If the patients prefer to have vaginal delivery, heparin over the last 2 weeks of gestation should be offered as an option."

Seems like it's possible for my wife to continue using Warfarin throughout her pregnancy.

"In pregnant patients with mechanical valves warfarin at a daily dose ≤5 mg seems to be the drug that provides the best antithrombotic effect with a reasonably low rate of untoward fetal complications."

Yep, now I feel more relieved, I really hope this pregnancy will go well. We'll see her doctor and let him decide whether to use Warfarin and change to Heparin, our last encounter with Heparin didn't end well though, my wife got a miscarriage but most importantly she is fine but I can't say for sure that Heparin caused the miscarriage, I really have no idea how it happened.