[Heart valve prosthesis and pregnancy].
Sixteen pregnancies were followed up in 13 patients with prosthetic heart valves: 8 pregnancies went to term under oral anticoagulation, 4 under heparin and 4 without anticoagulation. 9 healthy normal children were delivered; there were 2 still births and 5 abortions. On the maternal side 3 haemorrhages and thromboembolic episodes which involved 2 patients on heparin, one of whom died, were observed. The following points are apparent from our observations and a review of the existing medical literature: --the risk of thromboembolism is not increased. The marked clotting tendency of maternal blood post-partum contraindicates the withdrawal of anticoagulants during this critical period; --haemorrhagic complications are common with anticoagulants; --foetal loss is greatly increased; --the teratogenecity of vitamin-K antagonists is certain, but the risk is small. The problems of anticoagulation are discussed; theoretically heparin should be given during the 1st trimestre and from the 38th week to the second post-partum week. The patients should be closely supervised by both obstetrician and cardiologist and hospitalisation is advised for the last month of pregnancy. Normal vaginal delivery is usually possible.
D000014:Abnormalities, Drug-Induced; D000028:Abortion, Induced; D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects; D005260:Female; D005313:Fetal Death; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006470:Hemorrhage / Q000150:complications; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007743:Labor, Obstetric; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000209:etiology; D013923:Thromboembolism / Q000209:etiology; D014812:Vitamin K / Q000037:antagonists & inhibitors
D000925:Anticoagulants; D014812:Vitamin K; D006493:Heparin
Prothèses valvulaires cardiaques et grossesse.