how to inject heparin during pregnancyBlog

how to inject heparin during pregnancy

Already on long-term anticoagulation, e.g. Unfortunately, not knowing the cause of miscarriage makes it difficult to know what to expect if you choose to become pregnant again. This is called an embolus. x\_s=x8iu'I}pRN&_ v7/yY4g/d#e+Ll'o3[e]L4{)W>FhK?_.v3[IOg.tc:9L} Zp#%E^^GvMrTlf3y>>6qaf8t|E6J Hi there- I have been on lovenox and heparin for this pregnancy( ANA+) and I have found that warming the meds up for a few minutes makes it sting MUCH less. According to this study: In women who have a history of venous thromboembolism, weight-adjusted intermediate-dose low-molecular-weight heparin during the combined antepartum and postpartum periods didn't reduce the risk of recurrence compared with fixed low-dose low-molecular-weight heparin.Further study is needed to determine whether intermediate-dose low-molecular-weight heparin may be more . Heparin is an anticoagulant, which prevents blood clotting. Signs and symptoms of a DVT include, Skin that is warm to the touch, red, or discolored, A blood clot in the legs or arms can break off and travel to the lungs. As far as the bruise/swelling, it probably won't be your last one, but hopefully it will get better! I tend to insert the needle and inject the heparin slow too. The effectiveness and safety of different methods administering subcutaneous heparin (UFH or LMWH) during pregnancy have not been systematically evaluated. As the risk of losing blood is high during and post-pregnancy stages, heparin is considered largely effective in stopping blood clots. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. It is important that you change the site each time. Some people start early in pregnancy but others may have treatment only after delivery. DVT is potentially, and PE is definitely, life-threatening for both mother and baby. . AND, it's hard. Women's satisfaction with receiving subcutaneous heparin is highly important as thromboprophylaxis in pregnancy involves a cost burden, inconvenience, and side effects as a result of a longer duration. zo90q |%()J 69#YVWpC(H#Vg g A family or personal history of blood clots or a blood clotting disorder, Prolonged immobility (not moving a lot), such as during bed rest or recovery after delivery, Complications of pregnancy and childbirth, Certain long-term medical conditions, such as heart or lung conditions, or diabetes, Know the signs and symptoms of blood clots, A blood clot occurring in the legs or arms is called deep vein thrombosis (DVT). http://community.babycenter.com/post/a891375/tips_tricks_for_injections_-_list_em_here. Just curious as I am concerned I will develop more hard lumps. @TwinkleStars15 that's really awesome to hear! (I was diagnosed with a Sub-clavian Vein thrombosis 2008, Thrombophillya test boarder line) I was not told then that it would affect any future pregnancies so this . Good luck. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. It can cause birth defects and fetal bleeding. These injections are often provided alongside a low dose of "baby" aspirin. Recent findings: Low-molecular-weight heparins do not increase the risk of maternal bleeding during pregnancy. Learn about Blood Clots. Knowing the signs and symptoms of a blood clot is important to protect yourself and your baby during pregnancy and after delivery. In general, if a pregnant woman is at high risk for a blood clot or experiences a blood clot during pregnancy or after delivery, she may be prescribed a medicine called low-molecular weight heparin. There were no problems throughout the pregnancy. I was told today that I was going to have to Inject Clexane from now till 6 weeks after birth. <>/PageLabels 375 0 R>> cl_ZH[ @`:@1,G0.D:!`=A|F&l=H$Ih 6> I'2tWY6?5V!/VR$!hMd*4V A DVT can limit blood flow through the vein, causing swelling and pain, but there is a risk that it can break off and travel through the blood stream. Heparin is considered the anticoagulant of choice during pregnancy, although anticoagulation and maternal disease state may pose a risk to both the mother and fetus. 2 Remove the cap and roll the vial. I hardly bruise at all. If eligible trials had been identified, trial quality would have been assessed and data extracted, unblinded by review authors independently. endobj I started out numbing with ice but that just took too long lol. There have been studies which conclude that usage of heparin, in general, is harmful to both the child and the mother. Low-dose aspirin and low-molecular-weight heparin (LMWH . Heparin does not cross the placenta, and thus, it was surprising that a recent report concluded that heparin therapy during pregnancy was as risky as oral anticoagulant therapy. The incidence of refractory angina (22.9% in the placebo group) was significantly reduced to 8.5% ( P =0.002) in the heparin group and 10.7% in the heparin-plus-aspirin group ( P =0.11) but was 16.5% in the aspirin group. Be sure to talk with your healthcare provider to understand the best course of management for you. It must be given by injection into the fatty layer of tissue beneath the skins. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. Visiting and Attending Maternity Services, Covid during Pregnancy, Labour and After Birth, Southmead Hospital Charity - Supporting Maternity, Active Birth & Positions for Labour Video, Emergency Parking at Cossham Birth Centre Video, Short Stay Parking at Central Delivery Suite Video, Labour Room, Central Delivery Suite Video. Grasp the tip of the Needle-Trap and bend it away from the syringe. Tell your doctor if you have or have ever had heart disease, a stroke, deep venous thrombosis (DVT; blood clot in your leg), a pulmonary embolus (PE; blood clot in your lungs), or if you are going to have surgery. Side effects of heparin treatment may include bleeding and decreased bone density. Brian Levine, MD, MS, FACOG, is board-certified in obstetrics-gynecology, as well as reproductive endocrinology and infertility (REI). I'm a fan of medical intervention of necessary but I am really worried about getting pushed about and rushed. DOI: 10.1002/14651858.CD009136.pub2, Copyright 2023 The Cochrane Collaboration. All rights reserved. Check APTT or antifactor Xa level once in 7 days. 7 Clinical presentation varies from mild dyspnea and tachypnea to dramatic cardiopulmonary collapse. Two weeks since my D&C and I still have a hard lump on my leg. :) I do heparin twice a day, on my morning injection I do the left side and in the evening I do the right side. Pregnant? I haven't done anything differently that I'm aware of. In one study, women with recurrent pregnancy loss experienced a 71% subsequent live birth rate when treated with heparin and low-dose aspirin, compared to a 42% live birth rate for those given aspirin alone. Use heparin sodium during pregnancy only if the potential benefit justifies the potential risk to the fetus. Heparin Sodium Market - Covid-19 Impact and Recovery Analysis: We have been tracking the direct impact of COVID-19 on this market, as well as the indirect impact from other industries. I just switched to heparin (2x/day) and I do one side at night, the other in the morning. Heparin, sometimes called "standard heparin," is available as a liquid solution injected directly into the blood (intravenous or "IV") and only given to hospitalized patients, for instance . A PE may cause breathing problems, chest pain and coughing up blood but a large PE can cause collapse and may be life threatening. Please feel free to share the campaigns educational resources with friends and family. 5 For individuals with antiphospholipid syndrome, the benefits of heparin usually outweigh the risks. The idea of being heard without having to speak appeals to her. LMWHs are the agents of choice for antenatal thromboprophylaxis. Before you handle the syringe or vial of heparin, you should wash your hands thoroughly. And she would like to continue creating content on health and lifestyle. Clean the injection site with the alcohol wipe or cotton ball. 3 0 obj Stop Lovenox or Dalteparin for 12 hours and begin unfractionated heparin at 10,000 u q 12 hours. The three most common reasons for women starting heparin during pregnancy or after the birth are: For pregnant women and women who have given birth, heparin is the anticoagulant of choice and is recommended by the Royal College of Obstetricians and Gynaecologists. Right now I have a HUGE cruise on my right side because I scratched my tummy on a chair so I've been injecting just on the left side for about 2 weeks and I've been fine. I wouldn't inject where the bruise is cause that would probably hurt pretty bad. Heparin is given by injection or drip into a vein (intravenously) or by injection under the skin (subcutaneously) to treat and prevent these types of blood clots. intervals thereafter. Wipe the area with alcohol. The LMWH comes in preloaded syringes. I inject on both sides. LMWHs are replacing UFH as the first-choice medications for VTE treatment and prophylaxis in pregnancy.12,24,35 In nonpregnant women, randomized trials have shown LMWHs to have equivalent or better effectiveness compared with UFH.1,3,36 In pregnancy, a systematic review concluded that LMWH is safe and effective and that there is no evidence to favor one LMWH over another.35 Excretion in breast milk is minimal.37 Compared with UFH, LMWHs have lower rates of adverse effects, including heparin-induced thrombocytopenia, symptomatic osteoporosis, bleeding, and allergic reactions.35, Warfarin should be avoided during pregnancy. Most commonly, venous thrombosis occurs in the deep veins in the legs, thighs or pelvis and this is called a deep vein thrombosis or a DVT. CDC and NBCA have launched new content for their digital public health education campaign called Stop the Clot, Spread the Word. Heparin Use During Pregnancy Information for pregnant women or women who have given birth who are receiving low molecular weight heparin Heparin is an anticoagulant drug. Unfortunately, a 2010 study found that neither heparin nor low-dose aspirin improved birth rates in patients without antiphospholipid antibodies. This was extremely painful and it made it difficult to walk. Lovenox is perfectly safe. There have been several cases of miscarriage or child loss because effective steps were not taken at the right time to manage blood clotting issues. There is no evidence from randomised controlled trials to evaluate the best method of administering subcutaneous heparin to pregnant women. Should you have any concerns about your health, or of that of your baby or child, please consult with Low-molecular-weight heparin has largely replaced unfractionated heparin for prophylaxis and treatment in pregnancy. So today I noticed that I have a HUGE bruise to the left of my belly button. Sometimes it may be diluted and given to you as a slow injection into one of your veins (this is called an intravenous infusion). This medicine, injected under the skin, is used to prevent or treat blood clots during and after pregnancy. With life-threatening PE, thrombolytic therapy, percutaneous catheter thrombus fragmentation, or surgical embolectomy may be used, depending on local resources.33 Good evidence about the effectiveness and safety of thrombolytic therapy is lacking.34 Empiric anticoagulation may be started if clinical suspicion is high, then discontinued if VTE is excluded.12. 2010;362(17):1586-96. doi:10.1056/NEJMoa1000641. LMWH is given as an injection. How should this medicine be used? Are the heparin injections more painful than the progesterone? Airway, breathing, and circulation should be addressed immediately and may require management in the intensive care unit. Venous thromboembolism (VTE), which encompasses deep venous thrombosis (DVT) and pulmonary embolism (PE), complicates 0.5 to 3.0 per 1,000 pregnancies,1 and is the leading cause of maternal mortality in the United States.2 A 2007 American College of Physicians and American Academy of Family Physicians practice guideline,1 based on a systematic review,3 found only 11 high quality studies relating to the management of VTE in pregnancy, and concluded that there is inadequate evidence for definitive recommendations.1, Virchow's triad of hypercoagulation, vascular damage, and venous stasis all occur in pregnancy, resulting in a relative risk of 4.3 (95% confidence interval [CI], 3.5 to 5.2) for VTE in pregnant or postpartum women compared with nonpregnant women.4, VTE risk factors include age greater than 35 years, obesity (body mass index higher than 30 kg per2), grand multiparity, and a personal or family history of VTE or thrombophilia.5,6 Bed rest, immobility for four days or longer, hyperemesis, dehydration, medical problems (e.g., severe infection, congestive heart failure, nephrotic syndrome), preeclampsia, severe varicose veins, surgery, and trauma are also associated with an increased risk.6,7 Cesarean delivery significantly increases VTE risk compared with vaginal delivery (odds ratio [OR] = 13.3; 95% CI, 3.4 to 51.4).8, Approximately 50 percent of pregnant women with VTE have a thrombophilia, compared with 10 percent of the general population.5 Current evidence does not support universal thrombophilia screening.9 However, expert opinion suggests testing women with a personal or strong family history of thrombosis or thrombophilia.10 During pregnancy, results must be interpreted with caution, because protein S levels normally fall in the second trimester.11 Massive thrombus and nephrotic syndrome can decrease antithrombin levels, and liver disease decreases protein C and S levels.12, Thrombophilic disorders may be inherited or acquired.13,14 Factor V Leiden and prothrombin G20210A mutations are the most common.13 Antiphospholipid antibody syndrome, the most important acquired thrombophilia in pregnancy, is defined by the presence of antiphospholipid antibodies and one or more clinical manifestations, most commonly thrombosis or recurrent miscarriage.15 A positive test for lupus anticoagulant, or medium-to-high titers of anticardiolipin immunoglobulin G or M antibodies, provides adequate laboratory confirmation of antiphospholipid antibody syndrome if found twice at least six weeks apart.15, Thrombophilias are associated with pregnancy complications, including early and late pregnancy loss, intra-uterine growth restriction, and placental abruption.9, DVT occurs with equal frequency in each trimester and postpartum.16 During pregnancy, 78 to 90 percent of DVTs occur in the left leg5,7 and 72 percent in the ilio-femoral vein, where they are more likely to embolize.5 In nonpregnant patients, 55 percent are in the left leg and 9 percent in the iliofemoral vein.5. Let your provider know if you or anyone else in your family has ever had a blood clot. Heparin During Pregnancy - Is It Safe to Use? The best places for you to inject into are: The U-shape area around your belly button. I took heparin during my pregnancies (after having a DVT). Heparin should not be injected into a muscle. recurrent thrombosis. In extreme conditions, death has also been recorded. <> National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Healthcare Professionals: Training and Education, Signs and Symptoms of Blood Clots with Cancer, Blood Clot Risk Checklist for Cancer Patients, Healthcare-Associated Venous Thromboembolism, U.S. Department of Health & Human Services. This content is owned by the AAFP. I've read on here that it's necesary to change injection sites, but my dr. didn't say anything about that. Heparin is an anticoagulant drug. Her OB physician has called in a specialist who thinks the patient is experiencing heparin-induced thrombocytopenia. Due to the risks and uncertain benefits, heparin treatment is recommended only for those with a confirmed diagnosis of antiphospholipid syndrome or an inherited thrombophilia disorder. All rights reserved. Learn other interesting facts about blood clots. Pick up the syringe. I also made sure to request the insulin needs and I dont feel a thing with the needle going in or any burn/sting with the meds. Parenting.Firstcry.com accepts no liability for any errors, omissions or misrepresentations. She has written articles on pregnancy, parenting, and relationships. Quasi-randomised studies and cross-over trials were not eligible for inclusion.. Methods of administering subcutaneous heparin include intermittent injections versus indwelling catheters or programmable (auto) external infusion pumps, or any other devices to facilitate the subcutaneous administration of heparin (UFH or LMWH) during pregnancy. Centers for Disease Control and Prevention. Results - Information about being a carrier. While multiple contributing factors may be involved, sadly about 50% to 75% of the time, there is no known cause for recurrent miscarriages. i hope that this hasbeen some help. Here's how the blood thinner heparin can have a striking impact on pregnancy outcomes for certain patients. Using epoetin alfa injection products increases the risk that blood clots will form in or move to the legs, lungs, or brain. Copyright 2023 American Academy of Family Physicians. I really wouldn't worry about it if I were you but if you start to then you could call your dr. Blood Clot in the Uterus During Pregnancy: Causes, Complications & Treatment, 170 Baby Boy & Girl Name That Mean 'Gift from God', 600+ Unique & Cute Nicknames for Boys & Girls, Protecting Adolescents From Common Food and Waterborne Diseases, Why an Ideal pH 5.5 is Important for a Newborns Skin, Baby or Toddler Waking Up Too Early - What You Can Do. For patients with diagnosed underlying health conditions, treatment can be tailored to improve the chance of a successful pregnancy. She likes to write research-based articles that are informative and relevant. For individuals with antiphospholipid syndrome, the benefits of heparin usually outweigh the risks. The National Blood Clot Alliance (NBCA), a leading VTE advocacy group in North America, was funded through a five-year cooperative agreement to help address the lack of education on blood clots for the public. They postulated that unexplained miscarriages might be due to an unrecognized blood-clotting disorder. Download these checklists to learn more about your risks for blood clots and how to guide a discussion with your healthcare provider. Simcox L, Ormesher L, Tower C, Greer I. Thrombophilia and pregnancy complications. Anticoagulant therapy during pregnancy is indicated for the treatment and prophylaxis of venous thromboembolic disease and for the prevention and treatment of systemic embolism associated with valvular heart disease and/or . Venous thrombosis is a condition in which a blood clot (thrombus) forms in a vein (venous thrombosis). This is when the hormone is responsible for helping "prep" the uterus for the fertilized embryo. Methods of receiving heparin subcutaneously include giving an injection at regular intervals, or using an indwelling catheter and an infusion pump. Heparin Use in Pregnancy. American College of Obstetricians and Gynecologists. Some authorities recommend lower extremity venous compression ultrasonography as the next test because if DVT is present, anticoagulant treatment will be the same as for PE, and venous compression ultrasonography avoids fetal radiation exposure.12,28, When d-dimer testing and venous compression ultrasonography are inconclusive, multidetector-row (spiral) computed tomography has become the test of choice for diagnosing PE in pregnancy.12,24,26 Single-slice computed tomography is inadequate in diagnosing peripheral PE, but newer-generation spiral computed tomography, tested in nonpregnant patients, has shown positive and negative predictive values comparable with pulmonary angiography.27 Fetal exposure to radiation is lower with spiral computed tomography than with ventilation-perfusion (V/Q) scanning (less than 130 Gy and 370 Gy, respectively), and fetal exposure to spiral computed tomography nonionic contrast appears safe.29 Spiral computed tomography does expose the maternal breast to greater radiation, and V/Q scanning may be preferred in women with a family history of breast cancer.12 A cost-benefit analysis supports spiral computed tomography as the preferred test for diagnosing PE during pregnancy.30. We're thinking of having a doula which sounds like such a silly posh person thing to do, we're not posh but I really feel like I could do with having an experienced advocate in there with me at the sharp end. Sometimes it stings more than othersand sometimes I don't feel a thing! Do not inject this medication into a muscle. Now that my belly is a lot bigger, I inject into my love handles or side of upper thigh (do that while sitting). Saving Lives, Protecting People, also called venous thromboembolism or VTE. Dont let a blood clot spoil your joy. However, the risk of developing a pulmonary embolus, once a DVT has been diagnosed and treated, is extremely small. The discovery of LMWH has indeed been a boon to many mothers suffering from blood clotting problems as blood clotting does pose a major threat during the period of pregnancy. Other advantages are decreasing thrombophilic risk in COH ( controlled ovarian . Table 1 lists a typical therapeutic LMWH dose.10,12,32,41 The optimal monitoring protocol with LMWH is controversial. Anticoagulation options include low-molecular-weight heparins (LMWHs), unfractionated heparin (UFH), and warfarin (Coumadin; postpartum only). You are at increased risk for developing a blood clot. The experience of one miscarriage is devastating, let alone recurrent miscarriages. How can I tell that my baby is getting enough milk? Thank you, {{form.email}}, for signing up. Although, the low molecular weight heparin is considered safe to use with regards to pregnancy, the Unfractionated Heparin version used before had several health risks associated with it. Venous thromboembolism is the leading cause of maternal death in the United States. The role of thrombophilia in pregnancy. Choose a site on the right or left side of your belly, at least 5 centimetres (2 inches) from your belly button. This lowers your risk of life-threatening conditions like pulmonary embolism or heart attack. Could be that I am a bigger girl but I have found that the heparin shots are much easier than the lovenox shots. Staying hydrated during pregnancy helps prevent clots by keeping the blood from getting too thick, Roshan said. Some women might already be taking the injections, and some might begin during their term of pregnancy. U.S. National Library of Medicine, ToxNet. The form of heparin that's preferred during pregnancy is called low molecular weight heparin (LMWH). If a very small amount passed into breast milk it is broken down by stomach acids therefore any absorption by a breast fed baby is negligible. 1997-2023 BabyCenter, LLC, a Ziff Davis company. 1. After deep subcutaneous (intrafat) injections, tests for adequacy of dosage are best performed on samples drawn 4 to 6 hours after the injection. Read Also: Accidentally Donated Blood While Pregnant Preparing Heparin Download Article 1 Wash your hands. Cookies used to make website functionality more relevant to you. A sharps bin to dispose of the used needle and syringe. I found this out when I was giving my husband his Enbrel- this one get refrigerated- my hands were full so I stuck the syring in my bra (haha) so it wouldn't break in my pocket and he said that it was the least painful injection ever. I have had to inject blood thinners several times, over the years. I make sure to avoid veins, even if it takes me a few extra seconds I make sure I am in a good light and look to avoid them. Women are also advised to take LMWH after the babys birth as the risk of blood clots are high during the first six weeks post-birth. Keep reading to know whether the use of heparin during pregnancy is safe or not. 2015;16(12):28418-28428. doi:10.3390/ijms161226104, Battinelli EM, Marshall A, Connors JM. The effect of unfractionated heparin in assisted reproductive technology (ART) cycles is prevention of thrombosis in implantation site . You can access these resources either from the campaign web portal or directly through the links provided below: This video shares important information about blood clot signs and symptoms, and risks for blood clots in women who are pregnant or have recently delivered a baby. It was commented on recently (last week) so it should not be too far back. endobj use of this site indicates your agreement to be bound by the Terms of Use. A clot arising during this or a previous pregnancy. Signs and symptoms of a DVT include Swelling of the affected limb Pain or tenderness not caused by injury Should I have it checked? l= x FwdjEM!uULSQx44DVT There are various types of heparin the type we usually use is a Low Molecular Weight Heparin (LMWH) such as Enoxaparin (also known as Clexane) or Dalteparin. One nightI had a friend over who is a nurse and she watched me do my shot. Confirm the choice of the correct HEPARIN SODIUM INJECTION vial to ensure that the 1 mL vial is not confused with a "catheter lock flush" vial or other 1 mL vial of incorrect strength [se e Warnings and Precautions (5.1)]. Therapeutic anticoagulation is indicated when DVT or PE is diagnosed. A couple minor inconveniences to your day! Blood Clot Prevention Checklist for Pregnant Women, Blood Clot Risk Checklist for Pregnant Women, This Is Serious (Duke Haemostasis Center), Join the Public Health Webinar Series on Blood Disorders. Several methods of administering heparin (UFH or LMWH) subcutaneously have been introduced to prevent adverse pregnant outcomes. Heparin is also known as: Heparin Sodium Pregnancy Warnings Breastfeeding Warnings Heparin Pregnancy Warnings Animal studies have revealed increased resorptions at doses approximately 10 times higher than the maximum human daily dose based on body weight. Recently had a baby? I also find icing before helps with the pain, and icing after helps the spot to be not quite as tender the next day. KING, MD, MPH. However, they are harmful because they are associated with an increased risk of thromboembolic, hemorrhagic, or microcirculatory disturbances or placental dysfunction leading to fetal growth restriction or loss. Lovenox (enoxaparin) is an anticoagulant (blood thinner) that works by blocking the activity of certain blood-clotting proteins. The investigation found that a heparin regimen, which is administered by injection, did not reduce the incidence of serious blood clots, miscarriage or stillbirth among women deemed to be at. Heres why: Several other factors may also increase a pregnant womans risk for a blood clot: Too many women die from pregnancy-related complications and many more experience severe-pregnancy-related complications. We use cookies to improve your experience on our site. Heparin is a form of anticoagulant used to prevent blood from clotting. Approximately 1% of women experience recurrent miscarriages, according to the American College of Obstetricians and Gynecologists. Your risk of developing a thrombosis will be assessed in pregnancy and after the birth of your baby. Planning a Pregnancy or Expecting a Baby? Venous compression ultrasonography is the test of choice for diagnosing DVT because it is noninvasive, safe, and relatively inexpensive.12,20 In nonpregnant patients, it is 89 to 96 percent sensitive and 94 to 99 percent specific for symptomatic proximal lower extremity DVT.19 Sensitivity is lower in patients who are asymptomatic or have a calf DVT.19 In nonpregnant patients, computed tomography and magnetic resonance imaging have equivalent or better sensitivities and specificities than ultrasonography for DVT detection.23 Data are lacking for pregnant patients. :). Therefore, we performed a literature review of fetal/infant outcomes following anticoagulant therapy during pregnancy. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. How Effective Is Heparin During Pregnancy? The CDC recommends that women drink 10 glasses of liquid every day during pregnancy and 12 to 13 glasses every day while breastfeeding. Aspirin has a weak protective effect but is not recommended by experts to prevent DVT if the woman is at moderate to high risk. When I first started the Heparin they just told me not to put it in the exact same spot but they never said I couldn't do it on one side. Previous campaign content is available for general information about blood clots as well as information for people who have been hospitalized or recently discharged home.

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