Cardiac valve prostheses, anticoagulation, and pregnancy

Area of Science:

• Cardiology
• Obstetrics
• Pharmacology

Background:

• Heart valve replacement is a common procedure.
• Pregnancy in women with prosthetic heart valves presents unique challenges.
• Management of anticoagulation during pregnancy is critical.

Purpose of the Study:

• To report the outcomes of pregnancies in women with prosthetic heart valves.
• To analyze the impact of different anticoagulation therapies on maternal and fetal complications.
• To provide insights into the management of these high-risk pregnancies.

Main Methods:

• Retrospective analysis of 76 pregnancies in 51 women with prosthetic heart valves.
• Categorization of anticoagulation use: oral anticoagulants, heparin, or no anticoagulants.
• Documentation of fetal complications (spontaneous abortions, premature deliveries, stillbirths, neonatal deaths) and maternal complications (thromboembolism, hemorrhage, embolism, death).

Main Results:

• 71 deliveries occurred; 12 spontaneous abortions, 12 premature deliveries with 7 stillbirths, and 3 neonatal deaths were reported.
• Oral anticoagulants were associated with a higher incidence of fetal and neonatal complications.
• Maternal complications included thromboembolic episodes, hemorrhage, systemic embolism, and deaths, with varying associations to anticoagulation therapy.

Conclusions:

• Pregnancy in women with prosthetic heart valves requires careful management.
• The choice of anticoagulation therapy significantly impacts pregnancy outcomes.
• Further research is needed to optimize anticoagulation strategies for these patients.