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Southern Ocean County Hospital would like to thank everyone who e-mailed questions for this edition of Ask-The-Expert and would like to especially thank Dr. Natalia Rezvina for taking part in the program.

April : Pregnancy and Childbirth

Dr. Rezvina's answers are informational only and should not be used as a diagnosis or for treatment. Please talk to your physician about official diagnosis of your condition and treatment.

Question 1
I was told that I had a lupus anticoagulant and it may be responsible for pregnancy loss. What is this?

Lupus anticoagulant is a type of antiphospholipid antibodies. Presence of these antibodies affects the blood clotting process. Phospholipids are present on cells in the blood and on the surfaces of the lining cells of blood vessels. Lupus anticoagulant and other antiphospholipid antibodies, like anticardiolipin antibodies, attach to the surface of these phospholipids and disrupt normal blood clotting process. Contrarily to its name “anti”-against “coagulant” – substance stimulating formation of the clot, lupus anticoagulants are risk factors for thrombosis (excessive clotting).

Some people have these antibodies and have no symptoms. In others, it can lead to developing a blood clot in a vein or artery, recurrent pregnancy losses (miscarriages) or serious complications with pregnancy. Antiphospholipid antibodies syndrome is more common in women. It can be related to some autoimmune diseases, such as Lupus or other rheumatic diseases, or can be related to some medications or infections. In most cases we are not able to identify any specific causes why some people develop these antiphospholipid antibodies.

Yes, Lupus anticoagulant can be responsible for your pregnancy loss. The good news Is that we now know how to treat this condition in pregnancy to prevent complications and improve pregnancy outcomes. Usually care of a pregnant women with Lupus anticoagulant ( or antiphospholipd antibodies) is coordinated between high-risk pregnancy specialist (perinatologist) and your primary obstetrician. Close monitoring during pregnancy, starting from positive pregnancy test at home, until delivery is warranted. In some cases treatment with medications to “thin” the blood may be needed.

Question 2
Is there a limit to how many C-sections a women can have?

No, there is no limit to how many Cesarean Section ( C-section) women can have, but the question is “ Is it safe to have multiple C-Sections ?”

Large families are common in many countries and communities throughout the world. As the rate of primary cesarean deliveries increases and the rate of Vaginal Birth After Cesarean section (VBAC) decreases, the number of women who undergo multiple cesarean deliveries is increasing.

There is limited number of publications in the medical journals about potential problems associated with having multiple C-Sections. The highest number of repeat C/S in a patient reported is nine.

Compared with a second cesarean delivery, multiple cesarean deliveries are associated with more surgical difficulties and an increase in major surgical complications.

Dense adhesions (scar tissue within the abdomen) not only create difficulties for the surgeon but may also pose an increased risk to the patient by prolonging operation time and by increasing the risk of injury to adjacent organs, such as bladder and bowel. Risk of hemorrhage (excessive bleeding ) at the time of repeat C/S is also higher, which may lead to severe anemia ( low blood count of red blood cells) after the surgery and need for blood transfusion.

There is also an increased risk for abnormal localization of placenta ( placenta previa) which can cause bleeding during pregnancy and cause preterm delivery of the fetus. Another major complication with multiple (mostly 3 or more) is placenta accreta, when placenta deeply invades muscle of the uterus and is not able to detach after delivery of the infant. In this situation an obstetrician may have to remove the uterus (perform hysterectomy).

If you plan to have more then two-three children in the family, you may benefit from VBAC. VBACs are not without risks either. Talk to you doctor to see what delivery method is right for you.