[Anticoagulant therapy and obstetric management in a pregnant patient with mechanical prosthetic valve]

A 30-year-old female whose mitral valve had been replaced with a mechanical prosthetic valve 23 years ago gave birth to a healthy baby by cesarian section under controlled anticoagulant therapy. Warfarin was replaced with intravenous heparin just one week before cesarian section and heparin administration was stopped several hours prior to the operation which was successfully carried out without excessive blood loss. Although warfarin carries a risk of teratogenecity, fortunately, the baby had not any somatic malformation. We believe that pregnancy is not contraindicated in patients with mechanical prosthetic heart valves, however, a strict observation of the cardiac function during middle and late trimesters of gestation by echocardiography and planned anticoagulant therapy are necessary in order to prevent maternal congestive heart failure and thromboembolism and protect a neonate against intracranial hemorrhage.