Anticoagulation therapy during pregnancy of patients with artificial heart valves: fetomaternal outcome.
OBJECTIVE
The major problem is the need for anticoagulant therapy in patient with mechanical heart valves.


METHODS
The aim of the study was to analyze the course and outcome of pregnancies of patients with artificial mechanical heart valves with anticoagulant therapy. Study included 43 pregnancies leaded and terminated at the Institute of Gynecology and Obstetrics Clinical Center of Serbia in 20 years. We divided the patients in two groups depending on the type of anticoagulation therapy. Group I included 21 patients who were under Ethylbiscumacetate (Pelenthan) during the first 36 weeks of gestation, and intravenous Heparin in the last 4 weeks and after the delivery. Group II included 22 patients who received oral anticoagulant therapy all the time.


RESULTS
Worsening of the heart functional status happened in 6 patients (13.9%). The incidence of heart failure during the pregnancy was 13.9% and after the delivery 9.3%. The incidence of hemorrhagic complications was 11.6% during pregnancy and 14% after the delivery. Four patients had thromboembolic events before the pregnancy. The incidence of postpartal thromboembolic complications was 6.9% in group I. Two patients died due to the heart failure 3-7 days after the vaginal delivery. Maternal mortality was 4.6%. One neonatus died of hydrocephalus (2.5%) in group II. In our study there were no fetuses with congenital heart disease.


CONCLUSIONS
Pregnancies of patients with mechanical heart valves should be planned. We suggest ethylbiscumacetate in combination with Heparin as anticoagulation therapy during the pregnancy.
Plesinac
Snezana D
SD
Department of Fertility Control, Institute of Gynecology and Obstetrics, Clinical Center of Serbia, Koste Todorovica 26, Belgrade 11000, Serbia and Montenegro. plesinac@hotmail.com
Darko
Plecas V
PV
Pilic
Igor Z
IZ
Babovic
Ivana R
IR
D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005313:Fetal Death; D006333:Heart Failure / Q000453:epidemiology / Q000401:mortality; D006350:Heart Valve Prosthesis; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D019934:International Normalized Ratio; D008428:Maternal Mortality; D007752:Obstetric Labor, Premature / Q000453:epidemiology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy* / Q000453:epidemiology; D011250:Pregnancy Complications, Hematologic / Q000453:epidemiology / Q000517:prevention & control*; D011256:Pregnancy Outcome
D000925:Anticoagulants; D006493:Heparin