Pregnancy in patients with valvular prosthesis


Authors: J. Popelová
Authors‘ workplace: Centrum pro vrozené srdeční vady v dospělosti, Kardiochirurgické oddělení ;  Nemocnice Na Homolce, Praha
Published in: Kardiol Rev Int Med 2013, 15(3): 153-158
Category:

Overview

Pregnancy in women with a mechanical heart prosthesis represents increased risk both for the mother and for the child. In mechanical heart valves, low molecular weight heparin does not provide sufficient protection from thromboembolic complications. From this point of view warfarin is safer; it should not, however, be given between the sixth and 12th week of pregnancy due to the risk of embryopathy, especially if the dose exceeds 5 mg. If warfarin is given during labour, a Caesarean section should be performed. There is a risk of intracranial haemorrhage in the foetus. Va­ginal delivery is preferable if the mother is in a good clinical condition with good function of the prosthesis and heart and if she is treated with heparin during labour. The article gives a detailed overview of the current guidelines for anticoagulation treatment during pregnancy and delivery in women with a mechanical heart valve. Another and a significantly better option for girls and women during their fertile years are valve-sparing operations, Ross’ operation or implantation of a bio­prosthesis. These possibilities should be always carefully considered, even when they carry the risk of reoperation in the future. The elective reoperation does not carry higher risk than the first operation when performed by an experienced team.

Keywords:
pregnancy – mechanical heart prosthesis – thrombosis – anticoagulation – delivery


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Labels
Paediatric cardiology Internal medicine Cardiac surgery Cardiology
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