LOW-MOLECULAR-WEIGHT HEPARIN DURING PREGNANCY AND DELIVERY - PRELIMINARY EXPERIENCE WITH 41 PREGNANCIES

Objective: To describe experience with 41 pregnancies treated with the low-molecular-weight heparin enoxaparin. Methods: The medical charts of 34 when (a total of 41 pregnancies) treated between January 1992 an d March 1995 with the low-molecular-weight heparin enoxaparin were rev iewed. Most patients (87.5%) received one daily 40-mg injection. In al l cases, treatment was continued throughout labor, delivery, and the i mmediate postpartum period. Results: Therapy was administered for 5-28 0 days (median 91). One case of a thromboembolic event was recorded du ring treatment. No systemic or local side effects were reported. Durin g pregnancy, only one patient had mild vaginal bleeding, which resolve d spontaneously while therapy was continued. There was no excessive in trapartum bleeding in any of these patients, whether delivered vaginal ly or abdominally. During treatment, 19 of the 34 patients underwent 2 4 surgical procedures, including 13 cesarean deliveries, without exces sive bleeding. Epidural anesthesia was used during labor in nine of th e patients, with no specific complications. The corrected perinatal mo rtality rate, (ie, the rate of fetal death after 24 weeks' gestation p lus neonatal death, excluding a neonate with multiple anomalies) for t hose neonates delivered after 24 weeks' gestation was 2.7%. There were no cases of intraventricular hemorrhage in any of the neonates. Concl usion: This preliminary series, the largest reported to date, demonstr ates the relative safety and efficacy of low-molecular-weight heparin therapy in pregnancy and delivery.