Highlights the challenging balance between preventing valve thrombosis and managing significant hemorrhage risk in pregnant patients with mechanical heart valves.
Case highlights thrombosis-hemorrhage tradeoff in pregnant mechanical valve patients; leaves open optimal peripartum strategies.
Background: Therapeutic anticoagulation is required for all patients with prosthetic mitral valves. Anticoagulation with warfarin is recommended; however, warfarin is teratogenic in early pregnancy and therefore alternate anticoagulation regimens are suggested for pregnant patients. Case: A 28-year-old gravida 2, para 1 woman at 36 weeks’ gestation with a prosthetic mitral valve and a history of a corrected anomalous origin of the left coronary artery arising from the left pulmonary artery presented in labor. She underwent a spontaneous vaginal delivery complicated by a postpartum hemorrhage necessitating a hysterectomy. Conclusion: Management of mechanical valves in pregnancy is controversial. The provider must weigh the risks of life threatening valve thrombosis and malfunction against the risk of significant hemorrhage. This case report reviews peripartum anticoagulation protocols and management of massive hemorrhage in patients with prosthetic mechanical valves.
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Perdigao et al. (2016) studied this question.
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