Pregnant with Fact.V Leiden Heterozygous mutant

[noorj]

I am five weeks pregnant, this is my second pregnancy, i lost the first one durin my eight week and that was three months ago, i had bleeding which last for eight days then the fetus died.

I didnt take any thing for Fact.V Leiden Heterozygous mutant which was discovered after  lost the baby. Now am ive weeks pregnant and they are give me baby aspirine 100mg and folic acid and B6 and daily injections which i didnt start yet. I AM SEEING VERY LITTLE BLEEDING NOW, BROWN SPOTTING. I WENT TO ANOTHER DOCTOR WHO SIAd that i should stop the aspirne and to diregard the Fact.V Leiden Heterozygous mutant as he says it is not related.

am really confused and dont know wat to do and who shall o follow am afraid to loose the baby plz advise me asap.

Thanks.

Noor

[John Kim, M.D.]

Yes, this a complicated and controversial problem: women who are heterozygous for Factor V Leiden with a history of early pregnancy loss:
This is a good article that I found for you:  http://www.geneclinics.org/profiles/factor-v-leiden/details.html

"Prevention of pregnancy loss.  The current data on antithrombotic therapy in women with inherited thrombophilia and recurrent pregnancy loss are limited to several observational studies and two randomized trials.

In one study, 50 women with thrombophilia (including 20 factor V Leiden heterozygotes) and recurrent pregnancy loss were treated with enoxaparin throughout 61 subsequent pregnancies. The live birth rate was 75% with enoxaparin prophylaxis, compared to 20% in prior untreated pregnancies [Brenner et al 2000].

Another study reported a similar live birth rate of 77% with enoxaparin prophylaxis compared to 44% in untreated historical control women, suggesting a threefold greater likelihood of a favorable outcome. The beneficial effect of anticoagulation was most pronounced in women with factor V Leiden thrombophilia, although the small number of individuals studied precluded definitive conclusions [Carp et al 2003].

A prospective randomized trial compared prophylactic-dose enoxaparin and low-dose aspirin in women with factor V Leiden, the prothrombin 20210G>A mutation, or protein S deficiency and a single unexplained fetal loss. Enoxaparin prophylaxis was associated with a significantly higher live birth rate of 86% compared to 29% with aspirin, suggesting a 15-fold higher likelihood of a successful outcome. In the subgroup of women with heterozygous factor V Leiden (n=72) the live birth rate was 94% with enoxaparin prophylaxis, compared to 33% with aspirin, suggesting a 34-fold higher likelihood of a successful pregnancy outcome [Gris et al 2004].

A prospective randomized trial (Live-Enox) compared two different prophylactic doses of enoxaparin in thrombophilic women with a history of recurrent pregnancy loss (including 55 heterozygous for factor V Leiden). Both prophylactic doses (40 mg/day and 80 mg/day) achieved similar high live birth rates of 84% and 78%, respectively. These rates were substantially higher than the 23% live birth rate in prior untreated pregnancies [Brenner, Hoffman et al 2005].

No prospective randomized trials including an untreated control group confirming the benefit of low molecular weight heparin in preventing pregnancy loss in thrombophilic women have been performed. However, the concordant results of the studies cited above suggest that anticoagulation may improve pregnancy outcome in thrombophilic women.

Antithrombotic prophylaxis should be considered in selected women with factor V Leiden and unexplained pregnancy loss after an informed discussion of the risks and the data suggesting benefit [Kujovich 2005]. The evolving consensus in favor of prophylactic anticoagulation is reflected by the recent recommendations of the Seventh American College of Chest Physicians' Conference (ACCP) on antithrombotic therapy [Bates et al 2004]. ACCP guidelines suggest prophylactic-dose low molecular-weight or unfractionated heparin and low-dose aspirin for women with inherited thrombophilia and recurrent pregnancy loss or a single second- or third-trimester loss [Bates et al 2004].

Other pregnancy complications.  Data supporting the benefit of antithrombotic therapy in thrombophilic women with other pregnancy complications are considerably more limited. In the Live-Enox study, the incidence of preeclampsia, placental abruption, and fetal growth retardation was substantially lower with enoxaparin prophylaxis than in prior untreated pregnancies [Brenner, Bar et al 2005]. A study of thrombophilic women with prior fetal loss who received either enoxaparin or aspirin during a subsequent pregnancy showed that those who received enoxaparin had newborns with significantly higher birth weights and fewer classified as small for gestational age [Gris et al 2004]. However, neither study was designed to evaluate these complications as primary outcomes. ACCP guidelines suggest low-dose aspirin and prophylactic-dose low molecular-weight or unfractionated heparin for thrombophilic women with a history of severe or recurrent preeclampsia or placental abruption [Bates et al 2004]. Decisions about antithrombotic therapy in women with factor V Leiden and pregnancy complications should be based on an individual risk/benefit assessment. Assessment of the maternal thrombotic risk during pregnancy should also be incorporated into the decision regarding prophylaxis."

A European OB/GYN may not treat you at all (like one of your doctors) but in the U.S., more doctors would treat heterozygous women with a history of early pregnancy loss.  I certainly think that since you started bleeding the baby aspirin can be stopped but you have to consider heparin or low molecular weight heparin treatment for this pregnancy.  I would try to see a high risk doctor (Maternal Fetal Medicine Specialis) for their opinion for you.

[noorj]

thank you doctor for your reply, what i concluded from your answer is that this matter is still under study and that each doctor has his own treatment.

I went to a third doctor who also said that i shouldn't continue the aspirin or any kind of blood thinners. He also said that my pregnancy maybe week due to the fact that he couldn't see the fetus through external ultra sound and the blood.

But i have seen the fetus with the other doctor through an internal exam and my BHCG was almost 5500 a couple of days ago which I was told that it is good.

Doctor I don’t have a maternal fetal specialist in our country and doctors I have went to failed to tell explain the causes of bleeding which am still seeing. Well am 29 years old and I have been married for one year. But two doctors out of three advised to discontinue the aspirin and to take Duphaston as a treatment for threatened abortion.

Am I taking the right decision cause I decided to follow the advise of the two doctors,