Abstract

Venous thromboembolism (VTE) is amongst the leading causes of maternal death in developed countries. Several series have confirmed the safety and efficacy of LMWHs in pregnancy and it has become the favoured anticoagulant. Adverse skin reactions to LMWHs are rare but recognised events, whereupon a particular LMWH may be successfully replaced with another one. However if the skin symptoms do not improve an alternative must be sought.

Fondaparinux is a synthetic pentasaccharide. Whilst it has been extensively studied for use both in surgical prophylaxis and treatment of thromboembolic diseases; its use in pregnancy is less well documented.

We report 4 pregnancies in 3 women using Fondaparinux which adds to the available literature. All required thromboprophylaxis because of previous pregnancy associated VTE when they demonstrated broad cross-reactivity between several heparins and/or heparinoids.

In 3 pregnancies Fondaparinux was commenced in the first trimester and continued until 6 weeks postpartum. All continued without event resulting in vaginal delivery of well grown babies at term. There was no minor or major maternal bleeding (mean blood loss 250 mls) or thromboembolic event reported during the pregnancy or post-partum period. All babies were breastfed without effect. There was no congenital abnormality or neonatal bleeding. In a 4^th pregnancy LMWH was initially deferred until 20 weeks gestation where upon recurrent allergic skin reaction led to the change to Fondaparinux. Review at 37 weeks gestation was pre-empted by a complaint of reduced fetal movements with pathological CTG necessitating emergency caesarean section at her base hospital.