New and looking for advice

[kristiecreme43]

I am 31 yrs old. I have had 2mc's. The first in October 2011 and a d&c in April of this year after going to the doctor & no heartbeat could be found & baby measured at 8wks. Both pregnancies at the 11wk mark. I went in Sept and had blood work done and tested positive for PAI-1. I was referred to MFMS who told me all I needed to do was take baby aspirin a day for next pregnancy. When I asked about lovenox injections like others with PAI-1 have to take once pregnant she said they only done that with people who have pregnancy losses at 15 wks or more. I just dont feel this is right. I believe I need a second opinion. Can anyone give any advice? Thank you and God Bless

[sam10]

Hello and welcome. I don't know much about PAI-1. Somebody else with expetience will hopefully soon share their knowledge.
I encourage you to get a second opinion if you don't feel comfortable with your doctor/care. It is so important to trust your doctor.

[heather j]

Hi! Welcome to the PF! I also have the PAI-1 gene mutation (mine is 4G/4G). Do you know if you're heterozygous or homozygous? That would likely be the determining factor for whether a physician would proceed with anticoagulants in pregnancy. My MFM prefers to manage 4G/4G, and *sometimes* 4G/5G depending on labwork. The idea behind this mutation and how it plays out in pregnancy is that while the placenta is fighting to implant, you're clotting overtime to stop it (I don't profess to be very science-minded as evidenced by that description, LOL, but hopefully it makes sense); this can result in a shallowly implanted placenta. In my case, it resulted in a 5 lb baby at 36 weeks coupled with an abruption and HELLP syndrome. I've since had two more pregnancies. During my initial visit with my last, the NP who was doing my work-up was looking through my records and was amazed I hadn't experienced a miscarriage with the PAI-1 mutation. Miscarriages and Preeclampsia are possible complications as well as cardiovascular disease and stroke later in life. If you are not comfortable with your doctor, seek a second opinion. My protocol for pregnancy (my most recent was in 2010-11) is low-dose aspirin and lovenox (from weeks 6 through 6 weeks postpartum) with growth ultrasounds starting at 20 weeks (and every four weeks until deliver) and NST/BPP starting at 32 weeks. I'm on low-dose aspirin outside of pregnancy as well. I've had two pregnancies since my first preeclamptic one: #2 was a c-section at 37 weeks (6.2#) and #3 was a 37 weeker at 7#; both were PE-free. My sister, who lives across the country, consulted with an MFM at a very well-known teaching hospital (she also carries the PAI-1 4G/4G along with MTHFR and had PE with her first and only pregnancy) and her doctor didn't recommend any anticoagulants for her. She was dxed with PE around week 34; I was on bedrest by week 30. Feel free to message me privately if you'd like to chat more. There is so much more information available regarding this mutation than there was when I first began researching back in 2005. Best wishes to you for a healthy pregnancy and baby in the future.