Background: The peripartum management of women using low-molecular weight heparin (LMWH) is challenging. For those using prophylactic LMWH therapy there is much uncertainty and lack of consensus, whether scheduled delivery following a minimum of 12 hours off anticoagulation, would affect the chance of having neuraxial analgesia or result in improved maternal outcomes as compared to allowing spontaneous onset of delivery.

Aims: To examine the outcomes of planned induction of labor versus spontaneous onset of labor among women using prophylactic-dose LMWH therapy.

Methods: A retrospective cohort study, performed during 2018-2019 at a university hospital.

Results: Data from 199 women were analyzed, 121 (60.8%) women underwent planned induction of labor, whereas 78 (39.2%) were admitted following spontaneous onset of labor. Baseline characteristics of women were similar between the groups. The admission-to-delivery interval (median 4.7 vs. 29.3 hours), and the time intervals from the last LMWH injection to delivery (25.8 vs. 48.2 hours) and to the first postpartum LMWH injection (41.2 vs. 63.7 hours), were significantly shorter in those who presented with spontaneous onset of labor as compared to planned induction of labor (P< 0.001 for all comparisons). Among those with spontaneous onset of labor, 69 (88.5%) were eligible to receive neuraxial anesthesia, with no difference in relation to parity. Rates of PPH and blood transfusion were similar between the groups. While no thrombotic events were encountered in those with spontaneous onset of labor, four (3.3%) women who delivered following an induction of labor developed a thrombotic event during the postpartum course.

Conclusions: Planned induction of labor among women using prophylactic LMWH therapy, was associated with significantly prolonged duration of anticoagulation interruption as compared to those who developed spontaneous onset of labor. Allowing spontaneous onset of labor was associated with comparable rates of bleeding complications, with a low rate of not having access to neuraxial anesthesia.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/planned-induction-versus-spontaneous-delivery-among-women-using-prophylactic-anticoagulation-therapy/