To Study the Outcome of Pregnancy with Mechanical Prosthetic Heart Valves: An Experience with 24 Pregnancies from 2011-2015 – A 5 Years Retrospective Study

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Dr. Neena Somani
Dr. Neena Agrawal

Abstract

Background:Warfarin appears to offer best protection against thromboembolic complications as compared to other anticoagulants but it freely crosses the placenta. A dose dependent effect of warfarin on foetus results in embryotoxicity, therefore LMWH (low molecular weight heparin) has to be given in first trimester of pregnancy as it is non-embryotoxic and does not cross the placenta and induces a good anticoagulant effect.


Objective: This is a retrospective study to emphasize the safety of various anticoagulants, their doses, mode of delivery and a multidisciplinary approach to treat a pregnant woman with prosthetic valves so as to reduce maternal and foetal mortality and morbidity.


Materials and methods:This study was carried out from January 2011 to December 2015 in antenatal patients attending OPD of CHL Hospital Indore. There were 24 pregnant women with prosthetic heart valves, who had undergone valve replacement surgeries prenatally. We followed a protocol of shifting the patient to LMWH up to 12 weeks, followed by warfarin till 36 weeks & again LMWH till 72 hours of delivery.


Results:No fetomaternal complications were detected in our study with this approach.


Conclusion:Anticoagulation continues to be a problem with significant risks. For mothers with prosthetic heart valves the safest regime is - oral anticoagulation till 36 weeks (if dose of warfarin<5mg) followed by unfractionated heparin (UFH)/Low molecular weight heparin (LMWH) till 72 hours of delivery. In women who were prescribed a dose of warfarin >5mg, it was better to shift to LMWH for initial 12weeks to prevent embryo toxicity followed by oral warfarin till 36 weeks and then again shift to LMWH/UFH until 72 hours after delivery. This study was carried out to reduce the complications like thromboembolism, valve thrombosis, bleeding, endocarditis and embryo toxicity in such patients.


Keywords: Anticoagulants; Thromboembolism; Embryotoxicity; Fetomaternal complication

Published Oct 17, 2019

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