[Anticoagulant treatment and pregnancy. Apropos of 47 cases]

The authors report a series of 47 patients treated with anticoagulants during pregnancy. The commonest indication was the presence of an artificial heart valve (72.3% of cases), most often mitral (58.9%). Thirty seven women were treated with heparin (group I) and ten with oral anticoagulants (OA) (group II) during the first three months. There was one peripheral venous thrombotic event and 2 post-partum deaths. Obstetric complications were equally distributed between the 2 groups, with the exception of spontaneous abortions during the first three months and fetal deaths, which were commoner with OA. Hemorrhagic complications occurred in 17% of cases at the time of delivery and during the immediate post-partum period. One case of coumarin embryopathy was seen. This series confirms that three periods are dangerous in the context of anticoagulant treatment during pregnancy: the first three months, delivery and postpartum. We recommend the use of heparin during the first three months and at the end of pregnancy, restricting OA to the period between 4 and 9 months.