title: The safety of low molecular weight heparin therapy during labor.
abstract: OBJECTIVE
  Current recommendations are to discontinue low molecular weight heparin (LMWH) at least 24 hours prior to labor induction or administering epidural anesthesia. We assessed the safety of discontinuing LMWH 12-24 hours before delivery.
  
  
  METHODS
  We evaluated the prevalence of hemorrhagic complications during labor, cesarean or epidural catheter placement in 284 women treated with enoxaparin during pregnancy as compared with 16132 untreated women. Treated participants were divided into subgroups by the various intervals between last LMWH dose hemorrhage-prone events (vaginal delivery,epidural, cesarean etc.). The rate of hemorrhagic complications and hemoglobin values were compared between the study and control groups.
  
  
  RESULTS
  Postpartum hemorrhage was uncommon and occurred in 2.1% and 1.9% in study and control groups, respectively (p=0.13). Antenatal as well as postnatal hemoglobin values were very similar for treated and untreated women. No differences were noted between women who discontinued enoxaprin 12-24 hours before labor and those who discontinued treatment later with regard to maternal hemorrhagic complications. No spinal hematomas were report among 12792 treated and un-treated women who had epidural or spinal block. No hemorrhagic neonatal complications were encountered.
  
  
  CONCLUSIONS
  Discontinuing LMWH more than 12 hours before delivery is safe in relation to maternal hemorrhagic complications.
authors.affiliation: Department of Obstetrics and Gynecology, Lis Maternity Hospital, Aviv Sourasky Medical Center, The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. orshma@hotmail.co.il
authors.forename: Sharon
authors.initials: S
authors.lastname: Maslovitz
authors.forename: Ariel
authors.initials: A
authors.lastname: Many
authors.forename: Jessica Ascher
authors.initials: JA
authors.lastname: Landsberg
authors.forename: David
authors.initials: D
authors.lastname: Varon
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Lessing
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kupferminc
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects*; D004334:Drug Administration Schedule; D017984:Enoxaparin; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage* / Q000009:adverse effects*; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000139:chemically induced / Q000453:epidemiology; D007743:Labor, Obstetric; D011247:Pregnancy; D011644:Puerperal Disorders / Q000139:chemically induced / Q000453:epidemiology
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D006454:Hemoglobins; D006495:Heparin, Low-Molecular-Weight