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


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.

pregnancy – mechanical heart prosthesis – thrombosis – anticoagulation – delivery


1. Regitz‑ Zagrosek V, Lundqvist CB, Borghi C et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J 2011; 32: 3147– 3197.

2. Drenthen W, Boersma E, Balci A et al. Predictors of pregnancy complications in women with congenital heart disease. Eur Heart J 2010; 31: 2124– 2132.

3. Popelová J, Zatočil T, Vavera Z et al. Mechanical heart valve prosthesis in pregnancy –  multicenter retrospective observational study. Cor Vasa 2012; 54: 217– 222.

4. Siu SC, Sermer M, Colman JM et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation 2001; 104: 515– 521.

5. Khairy P, Ouyang DW, Fernandes SM et al. Pregnancy outcomes in women with congenital heart disease. Circulation 2006; 113: 517– 524.

6. Siu SC, Colman JM, Sorensen S et al. Adverse neonatal and cardiac outcomes are more common in pregnant women with cardiac disease. Circulation 2002; 105: 2179– 2184.

7. Chan WS, Anand S, Ginsberg JS. Anticoagulation of pregnant women with mechanical heart valves: a systematic review of the literature. Arch Intern Med 2000; 160: 191– 196.

8. Roos‑ Hesselink JW, Ruys TP, Stein JI et al. Outcome of pregnancy in patients with structural or ischaemic heart disease: results of a registry of the European Society of Cardiology. Eur Heart J 2013; 34: 657– 665.

9. McLintock C, McCowan LM, North RA. Maternal complications and pregnancy outcome in women with mechanical prosthetic heart valves treated with enoxaparin. BJOG 2009; 116: 1585– 1592.

10. Abildgaard U, Sandset PM, Hammerstrom J et al.Management of pregnant women with mechanical heart valve prosthesis: thromboprophylaxis with low molecular weight heparin. Thromb Res 2009; 124: 262– 267.

11. Yinon Y, Siu SC, Warshafsky C et al. Use of low molecular weight heparin in pregnant women with mechanical heart valves. Am J Cardiol 2009; 104: 1259– 1263.

12. Elkayam U, Bitar F. Valvular heart disease and pregnancy: part II: prosthetic valves. J Am Coll Cardiol 2005; 46: 403– 410.

13. Oran B, Lee‑ Parritz A, Ansell J. Low molecular weight heparin for the prophylaxis of thromboembolism in women with prosthetic mechanical heart valves during pregnancy. Thromb Haemost 2004; 92: 747– 751.

14. Menschengieser SS, Fondevila CG, Santarelli MT et al. Anticoagulation in pregnant women with mechanical heart valve prostheses. Heart 1999; 82: 23– 26.

15. Ashour ZA, Shawky HA, Hassan Hussein M. Outcome of pregnancy in women with mechanical valves. Tex Heart Inst J 2000; 27: 240– 245.

16. Sadler I, McCowan L, White H et al. Pregnancy outcomes and cardiac complications in women with mechanical, bio­prosthetic and homograft valves. BJOG 2000; 107: 245– 253.

17. Schaefer C, Hannemann D, Meister R et al. Vitamin K antagonists and pregnancy outcome. A multi‑centre prospective study. Thromb Haemost 2006; 95: 949– 957.

18. Vitale N, De Feo M, De Santo LS et al. Dose‑dependent fetal complications of warfarin in pregnant women with mechanical heart valves. J Am Coll Cardiol 1999; 33: 1637– 1641.

19. van Driel D, Wesseling J, Sauer PJ et al. Teratogen update: fetal effects after in utero exposure to coumarins overview of cases, follow‑up findings, and pathogenesis. Teratology 2002; 66: 127– 140.

20. Sillesen M, Hjortdal V, Vejlstrup N et al. Pregnancy with prosthetic heart valves –  30 years’ nationwide experience in Denmark. Eur J Cardiothorac Surg 2011; 40: 448– 454.

21. Cotrufo M, De Feo M, De Santo LS et al. Risk of warfarin during pregnancy with mechanical valve prostheses. Obstet Gynecol 2002; 99: 35– 40.

22. Vahanian A, Alfieri O, Andreotti F et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 2012; 33: 2451– 2496.

23. North RA, Sadler L, Stewart AW et al. Long‑term survival and valve‑related complications in young women with cardiac valve replacements. Circulation 1999; 99: 2669– 2676.

24. Avila WS, Rossi EG, Grinberg M et al. Influence of pregnancy after bio­prosthetic valve replacement in young women: a prospective five‑year study. J Heart Valve Dis 2002; 11: 864– 869.

25. Bates SM, Greer IA, Hirsh J et al. Use of antithrombotic agents during pregnancy: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126 (Suppl 3): 627– 644.

26. Abbas AE, Lester SJ, Connolly H. Pregnancy and the cardiovascular system. Int J Cardiol 2005; 98: 179– 189.

Paediatric cardiology Internal medicine Cardiac surgery Cardiology
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