Pregnancy following cardiac valve replacement surgery

OBJECTIVES: To study the outcome of pregnancy in women with artificial heart valves and to compare the maternal and perinatal outcome in mechanical and bioprosthetic valves. METHOD: Retrospective analysis of 34 pregnancies in 29 women who conceived after cardiac valve replacement was carried out. RESULTS: The majority of women (76.4%) delivered within 5 years of valve replacement. Anticoagulants were administered in 79.4% of pregnancies. Maternal mortality was 2.9% and maternal morbidity in the form of heart failure, atrial fibrillation, valve thrombosis, thromboembolism, bleeding complications and non-functioning prostheses were 2.9%, 5.8%, 2.9%, 2.9%, 11.7% and 2.9%, respectively. The incidence of prematurity was 5.8% and small for gestational age babies was 11.7%. There was no case of abortion. Two babies (5.8%) were still born, one of which had malformations. Maternal complications were significantly higher in women with bioprostheses, though the complications were more grave in the mechanical prostheses group. The perinatal outcome was almost similar in both the groups. CONCLUSION: The perinatal outcome was not different in women with bioprosthetic valves from the ones with mechanical prostheses, but the maternal morbidity was more in women with bioprosthetic valves. Coumarin derivatives were safe and effective and did not lead to embryopathy.