Pregnancy outcomes in women with mechanical heart valves.
OBJECTIVE
To evaluate maternal complications and perinatal outcomes in women with mechanical heart valves treated with warfarin and heparin during pregnancy.


METHODS
A retrospective chart review was performed on 45 pregnancies in 28 women who were previously fitted with mechanical valve prostheses and treated between 1991 and 2005 at Seoul National University Hospital. Outcome parameters were maternal complications and perinatal outcomes.


RESULTS
Overall, there were 27 live births (60%), 7 stillbirths (15.6%), 2 therapeutic terminations in the second trimester (4.4%), 9 first-trimester spontaneous abortions (20%) and 2 neonatal deaths after preterm delivery. After excluding 9 first-trimester spontaneous abortions and 3 pregnancies administered warfarin throughout pregnancy, there were significantly more live births among patients administered heparin only after a diagnosis of pregnancy than among those administered warfarin from the second trimester (11 of 11 vs. 13 of 22, p = 0.015). One patient with mitral valve thrombosis during heparinization in the first trimester received valve replacement surgery and then aborted. Late postpartum hemorrhage occurred in 1 patient. All stillbirths and therapeutic terminations occurred in women being administered warfarin.


CONCLUSIONS
Warfarin use from the second trimester in combination anticoagulation regimens increases the risk of an adverse perinatal outcome.
Kim
Byoung Jae
BJ
Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 110-744, Korea.
An
So Jung
SJ
Shim
Soon-Sup
SS
Jun
Jong Kwan
JK
Yoon
Bo Hyun
BH
Syn
Hee Chul
HC
Park
Joong Shin
JS
D000022:Abortion, Spontaneous / Q000453:epidemiology; D000032:Abortion, Therapeutic / Q000706:statistics & numerical data; D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D001021:Aortic Valve; D005260:Female; D005313:Fetal Death; D005865:Gestational Age; D006350:Heart Valve Prosthesis; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008943:Mitral Valve; D007752:Obstetric Labor, Premature / Q000453:epidemiology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology*; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D013927:Thrombosis / Q000453:epidemiology; D014859:Warfarin / Q000009:adverse effects* / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin