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EMAK
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Joined: 26 Nov 2006
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 Posted: Thu Feb 01, 2007 10:08 pm Post subject: Warfarin |
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Please I found this:
If a woman on warfarin starts to labour, CS will be the preferred mode of delivery....True....
Is that really true?..and how??  |
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wolverine
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Joined: 16 Jan 2007
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| Posted: Fri Feb 02, 2007 12:19 am Post subject: |
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Difficult.
From what i know warfarin is only indicated in pregnancy in women with prosthetic valves and this is not an indication for a C/S. Steps you would take if goes into labour are a. stop warfarin! b. check INR c. if needs reversal FFP 15mls/kgr and vitamin K 2mg slowly IV d. have bloods ready for transfusion e. active management of 3rd stage etc.
I can't see why C/S. |
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Nick Raine-Fenning
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Joined: 27 May 2006
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| Posted: Fri Feb 02, 2007 12:36 am Post subject: Re: Warfarin |
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| EMAK wrote: | | If a woman on warfarin starts to labour, CS will be the preferred mode of delivery.... |
Nonsense ... do I need to explain or is it self evident that blood loss is higher after CS?? 
Where do you read rubbish like this ... the authors should be shot!
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EMAK
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| Posted: Fri Feb 02, 2007 7:09 am Post subject: |
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may be it is typing or printing error  |
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Nick Raine-Fenning
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| Posted: Fri Feb 02, 2007 7:41 am Post subject: |
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| EMAK wrote: | | may be it is typing or printing error |
Let's hope so 
I am sure this is wrong.
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rpwalavalkar
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| Posted: Fri Feb 02, 2007 8:04 pm Post subject: |
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nick, the authors should be shot!!! 
agree with wolverine, that is the management of a woman on warfarin.
one should try n avoid traumatic delivery and operating on a patient who is fully anticoagulated unless there is a strong obstetric reason.
there is a very realistic risk of intra and post op haemorrhage and haematoma formation.
i'll say FALSE
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Dr Miss. Raj Walavalkar MBBS MRCOG
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Nick Raine-Fenning
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| Posted: Sat Feb 03, 2007 10:11 am Post subject: |
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| rpwalavalkar wrote: | | nick, the authors should be shot!!! |
You go get them girl ...  |
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mridulaben
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Joined: 08 Nov 2006
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Location: Brunei
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| Posted: Sat Feb 03, 2007 10:28 am Post subject: Re: Warfarin |
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| EMAK wrote: | Please I found this:
If a woman on warfarin starts to labour, CS will be the preferred mode of delivery....True....
Is that really true?..and how?? |
I WAS ALSO SHOKED BUT READ IN TOG vol 9, LATEST THAT WARFARIN WITHIN 2 WEEKS OF LABOUR IS AN INDICATION FOR LSCS.
i |
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Nick Raine-Fenning
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Posts: 1852
Location: Nottingham
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| Posted: Sat Feb 03, 2007 10:35 am Post subject: Re: Warfarin |
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| mridulaben wrote: | | I WAS ALSO SHOKED BUT READ IN TOG vol 9, LATEST THAT WARFARIN WITHIN 2 WEEKS OF LABOUR IS AN INDICATION FOR LSCS. |
Interesting ... looks like we need to do some deeper investigation
Please try not to shout mridulaben. Shouting refers to the use of CAPITALS!
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wolverine
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| Posted: Sat Feb 03, 2007 12:57 pm Post subject: |
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| Thinking of the high INR that the baby might have? avoid traumatic delivery? But even with known thrombocytopenic fetuses there are studies (I think from Netherlands for babies with alloimune thrombocytopenia) that vaginal birth does not increase the risk of bleeding! |
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Nick Raine-Fenning
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| Posted: Sat Feb 03, 2007 1:39 pm Post subject: |
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| Exactly - the chance of an intracranial event in compromised fetuses is not necessarily improved by caesarean which itself can be difficult. |
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vani s
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| Posted: Sat Feb 03, 2007 6:48 pm Post subject: |
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so what is the conclusion?  |
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wolverine
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| Posted: Sat Feb 03, 2007 7:26 pm Post subject: |
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| I'd say False. Does the TOG give any explanation why? |
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rpwalavalkar
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| Posted: Sat Feb 03, 2007 11:01 pm Post subject: |
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i'm saying false too
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mridulaben
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Location: Brunei
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| Posted: Sun Feb 04, 2007 6:55 am Post subject: |
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| Sorry Nick for the anger. I did not mean thatway. Actually i was & when i went through the article in TOG vol 9. Actually it is given under cardiac disease in pregnancy. There is no explaination given. There is a table mentioning indications for LSCS in cardiac disease, in which they have mentioned warfarin therapy within 2 weeks. Just check it, or am i misunderstanding. Any way i also think it is False, but now what do we answer??? |
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