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Related Experiment Videos

Pregnancy in patients after valve replacement.

C Oakley, P Doherty

    British Heart Journal
    |November 1, 1976
    PubMed
    Summary

    Pregnant women with artificial heart valves tolerated pregnancy well. Oral anticoagulants increased fetal loss and malformations; warfarin use is strongly discouraged due to teratogenic risks.

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    Area of Science:

    • Cardiology
    • Obstetrics
    • Pharmacology

    Background:

    • Pregnancy in women with artificial heart valves presents unique challenges.
    • Rheumatic heart disease and valve replacement in young women are becoming less common.
    • Cardiologists often adopt a cautious approach in managing these high-risk pregnancies.

    Purpose of the Study:

    • To evaluate pregnancy outcomes in women with prosthetic heart valves.
    • To compare the safety and efficacy of anticoagulation versus no anticoagulation during pregnancy.
    • To assess the risks associated with specific types of artificial valves and anticoagulant medications.

    Main Methods:

    • A questionnaire-based retrospective study of 34 patients with 39 pregnancies after valve replacement in UK cardiac centers.
    • Data collected on maternal and fetal outcomes, valve types, and anticoagulant use (heparin, warfarin).
    • Comparison of outcomes between pregnant women who received anticoagulants and those who did not.

    Main Results:

    • 30 healthy babies were born from 39 pregnancies.
    • No anticoagulants: 24 pregnancies resulted in 23 healthy babies and 1 spontaneous abortion; no maternal deaths or thromboembolic events.
    • Anticoagulants: 15 pregnancies resulted in 7 healthy babies, with significant fetal losses (stillbirth, intrauterine death, abortions) and 2 maternal deaths; warfarin use was associated with malformations and fetal hemorrhage.

    Conclusions:

    • Women with artificial heart valves can generally tolerate the hemodynamic stress of pregnancy.
    • Oral anticoagulants, particularly warfarin, significantly increase fetal wastage and malformation risks.
    • Biological valves demonstrated advantages in this series; warfarin should be avoided in pregnant patients with prosthetic valves.

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