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Pregnancy in open heart surgical patients at Kenyatta National Hospital
1Department of Surgery, College of Health Sciences, University of Nairobi.
Background:
In the past, the Kenyatta National Hospital heart unit policy has been to discourage pregnancy among patients following open heart surgery for valve replacement, in view of the adverse effects of warfarin.
Objective:
To review the occurrence of pregnancy in open heart patients following discharge from hospital, and to compare the incidence with national figures.
Design:
Retrospective and prospective.
Setting:
Kenyatta National Hospital, Nairobi.
Patients:
Of the 239 female patients operated upon at the cardiothoracic unit of the KNH during the period June 1973 and September 1998, 108 met the inclusion criteria; 56 of them had valve replacement surgery.
Results:
At the time of surgery, 31% of all the female patients were in the reproductive age group of 14 to 45 years. Only two per cent were older than 45 years. Follow up was 490 patient years for the entire group, and 318 patient years for all with valvulopathy. For the whole group, irrespective of age, pregnancy rate was 6% and 15% at five and ten years of follow up respectively. There was no statistically significant difference between pregnancies occurring in patients who had valve surgery and those who had surgery for congenital heart disease, p = 0.35.
Conclusion:
Despite our previous policy of discouraging pregnancy among patients with mechanical valves, a significant number of them still became pregnant. The pregnancy rate in these patients was approximately one quarter of that in the general Kenyan population. An increasing number of centres now favour continuation of warfarin during pregnancy, the risks of maternal and foetal complications with heparin seem to be greater than the likely drawbacks associated with warfarin use in these patients.