title: Mechanical valve prosthesis and anticoagulation regimens in pregnancy: a tertiary centre experience.
abstract: OBJECTIVE
  This study was undertaken to analyze the maternal and perinatal outcome in women with prosthetic heart valves on different anticoagulant regimens.
  
  
  METHODS
  A retrospective chart review of pregnancies in 40 women with mechanical valve prostheses at a tertiary referral centre from 1997 to 2010. The main outcome measures were major maternal complications and perinatal outcome.
  
  
  RESULTS
  The valves replaced were mitral (67.5%), aortic (15.0%), or both (17.5%). Forty-nine pregnancies (72.1%) resulted in live births, 3(4.4%) had stillbirths, and 13(19.1%) had spontaneous abortions and 1(1.4%) underwent therapeutic abortions. The live birth rate was higher in women on heparin (78.3%) compared with those on warfarin (66.9%). There were 2 maternal deaths due to acute mitral valvular thrombosis while on acenocoumarol in the second trimester. Hemorrhagic complications occurred in 3 patients on heparin in the postpartum period, 2 of whom required transfusion. In addition one patient who was on acenocoumarol developed secondary hemorrhage.
  
  
  CONCLUSIONS
  No anticoagulant regimen can be said to be entirely safe for use during pregnancy as there is a degree of risk with each regimen. Further larger studies are needed to come up with sufficient evidence-based recommendations for the best possible management of such patients to reduce the maternal risks after mechanical heart valve replacement without compromising fetal outcome.
authors.affiliation: Department of Obstetrics & Gynaecology, Postgraduate Institute of Medical Education & Research, Sector-12, Chandigarh 160012, India.
authors.forename: Vanita
authors.initials: V
authors.lastname: Suri
authors.forename: Anish
authors.initials: A
authors.lastname: Keepanasseril
authors.forename: Neelam
authors.initials: N
authors.lastname: Aggarwal
authors.forename: Seema
authors.initials: S
authors.lastname: Chopra
authors.forename: Rashmi
authors.initials: R
authors.lastname: Bagga
authors.forename: Pooja
authors.initials: P
authors.lastname: Sikka
authors.forename: Rajesh
authors.initials: R
authors.lastname: Vijayvergiya
mesh_terms: D000022:Abortion, Spontaneous / Q000209:etiology; D000046:Academic Medical Centers; D000074:Acenocoumarol / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008499:Medical Records; D008943:Mitral Valve / Q000601:surgery; D006473:Postpartum Hemorrhage / Q000209:etiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology* / Q000517:prevention & control; D011249:Pregnancy Complications, Cardiovascular / Q000601:surgery; D011250:Pregnancy Complications, Hematologic / Q000209:etiology / Q000517:prevention & control*; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin; D000074:Acenocoumarol