The obstetrical patient with a prosthetic heart valve

Definitive recommendations on anticoagulation strategy in pregnant women who have prosthetic heart valves are lacking because of the paucity of prospectively collected data. The use of warfarin, UFH, LMWH, or any combination of these choices has potentially adverse outcomes for the mother and fetus. Although there is no treatment option that has proven to be completely satisfactory, there is agreement that failures are most often due to underdosing and the lack of intensive monitoring of anticoagulation. A careful discussion with the patient must be undertaken so that she and the clinician can come to a decision about the most appropriate protocol.