title: Pregnancy After Cardiac Surgery.
abstract: Heart disease is one of the common, indirect obstetric causes of maternal death. Management of these cases may challenge the entire team providing care to the mother and fetus. Advances in cardiac surgery has improved quality of life and level of functioning of cardiovascular system of patients with congenital or acquired heart disease. These diseases complicate 0.1-4 % pregnancies. Maternal complications in the form of thromboembolic, hemorrhagic episode and heart failure may occur. The fetus is in danger of effects of oral anticoagulation therapy and other medications given to the patient in order to support cardiovascular system, intrauterine growth restriction and danger of hypoxia. In recent era, we are facing more pregnant patients with previous history of surgical correction of congenital or rheumatic heart disease. In this review, we have attempted to draw a management protocol of such patients based on the available literature and various international guidelines. In pregnant women with mechanical heart valves, recent data support warfarin use throughout pregnancy, followed by a switch to heparin and planned induction of labor. However, the complexity of this situation demands a cafeteria approach where the patient herself can choose from the available options that are supported by evidence-based information. Preconception counseling, evaluation and antenatal high-risk management protocol with the help of cardiologist and cardiac surgeon improves maternal and neonatal outcome.
authors.affiliation: Department of Obstetrics and Gynecology, Chirayu Medical College and Hospital, Bhopal-Indore Highway, Near Bairagarh, Bhopal, Bhopal, MP 462030 India.
authors.forename: Anjali Vivek
authors.initials: AV
authors.lastname: Kanhere
authors.affiliation: Department of Cardiothoracic Surgery, Chirayu Cardiac Center, Chirayu Medical College and Hospital, Bhopal, Bhopal-Indore Highway, Near Bairagarh, Bhopal, MP 462030 India.
authors.forename: Vivek Madhav
authors.initials: VM
authors.lastname: Kanhere
keywords: Anticoagulation; Cardiac surgery; Heparin; Pregnancy; Warfarin