A G2P1 on warfarin presents at 38 weeks in labor: Next step
**Core Concept**
Warfarin is a vitamin K antagonist (VKA) that inhibits the synthesis of clotting factors II, VII, IX, and X in the liver. This makes it contraindicated in pregnancy, especially during the third trimester when the risk of fetal intracranial hemorrhage is high.
**Why the Correct Answer is Right**
In a pregnant woman on warfarin, the next step is to discontinue the medication and administer vitamin K to the mother and newborn. This is because warfarin crosses the placenta and can cause fetal bleeding and intracranial hemorrhage. Vitamin K administration helps to counteract the effects of warfarin and prevent fetal bleeding. The American College of Obstetricians and Gynecologists (ACOG) recommends discontinuing warfarin at least 5 days before delivery and administering vitamin K to the newborn within the first hour of life.
**Why Each Wrong Option is Incorrect**
* **Option A:** Continuing warfarin is incorrect because it increases the risk of fetal intracranial hemorrhage and bleeding complications.
* **Option B:** Administering fresh frozen plasma (FFP) is incorrect because it may not be effective in reversing the anticoagulant effects of warfarin and can cause volume overload.
* **Option C:** Administering heparin is incorrect because it is not a suitable alternative to warfarin in pregnancy and can also cause bleeding complications.
**Clinical Pearl / High-Yield Fact**
Warfarin is contraindicated in pregnancy, especially during the third trimester, and should be discontinued at least 5 days before delivery to minimize the risk of fetal bleeding and intracranial hemorrhage.
**Correct Answer:** C. Administering fresh frozen plasma (FFP) is incorrect because it may not be effective in reversing the anticoagulant effects of warfarin and can cause volume overload.