Feto-Maternal Complications of Anticoagulant Use Before and After Childbirth

Abstract

Anticoagulants prevent blood clotting, but their use in pregnancy poses challenges due to bleeding risks, particularly during delivery and postpartum. Objectives: To evaluate the maternal and fetal complications associated with anticoagulant use before and after childbirth, considering the safety and effectiveness of low molecular weight heparin and Warfarin. Methods: A cohort study was conducted at the Tertiary Care Hospital of Sindh, from August 2022 to July 2023. 266 pregnant women were chosen via consecutive sampling. Pregnant women with a gestational age of > 12 weeks, aged 18-35 years probably taking anti-coagulation therapy during pregnancy and puerperium were included in the study. While women suffering from any major systemic illness and women taking any other potential teratogenic drugs were excluded. Results: Maternal complications occurred in 53% of participants, with postpartum hemorrhage being the most frequent (19.9%), significantly higher in the low molecular weight heparin group (p<0.05). Pre-eclampsia affected 10.5% of participants, predominantly in low molecular weight heparin users (p=0.028). Fetal complications were reported in 59.3% of cases, with intrauterine growth restriction (13.5%) and premature birth (18.0%) being the most common. Stillbirths were more frequent among Warfarin users. Neonatal intensive care admission was required for 11.3% of infants, with low molecular weight heparin exposure showing the highest incidence. Conclusions: It was concluded that low molecular weight heparin was with poor maternal outcomes such as postpartum hemorrhage, wound hematoma, deep vein thrombosis, and pre-eclampsia, while fetal complications included intrauterine growth restriction, stillbirth, premature birth and low birth weight.