Why the study?
Managing valve disease during pregnancy requires balancing maternal outcomes and fetal risks, with no anticoagulant regimen being entirely safe.
What are the optimal anticoagulation and surgical management strategies to balance maternal and fetal risks in pregnant women with cardiac disease?
What are the optimal anticoagulation and surgical management strategies to balance maternal and fetal risks in pregnant women with cardiac disease?
Managing pregnant women with prosthetic heart valves requires a multidisciplinary approach to balance maternal thromboembolic risks with fetal teratogenic risks, as no single anticoagulant regimen is entirely safe.
Supports individualized anticoagulation decisions in cardiac pregnancy; leaves open identification of safer regimens balancing maternal-fetal risks.
Women with native heart valve disease who are considering getting pregnant should have a complete risk estimation to determine whether an intervention is required prior to becoming pregnant and, if so, to determine when it should be performed and what kind of surgical therapy will be used. Pregnancy is linked to early and late structural valve degeneration in women who have bioprostheses, suggesting a high reoperation rate. A mechanical valve during pregnancy increases the risk of maternal complications such as valve thrombosis and mortality. The claim that women with defective hearts should not become pregnant was driven by the high maternal death rate among cardiac patients who became pregnant. A preoperative anticoagulation therapy trial helped women scheduled for valve replacement to acquire complete information as to the choice of the prosthetic device. Integrated risk stratification scheme for pregnant patients with valvular heart disease, with WHO classification and an algorithmic approach to both preconception counseling and anticoagulation strategy as outlined here, as well as early referral to a cardiologist with expertise in the management of cardiac disease and pregnancy for these complex patients is recommended. However, in reality, some women present while pregnant and valve disease needs to be managed, balancing maternal outcome and fetal risk. In general, optimizing the hemodynamic situation of the mother is also beneficial to the fetus. However, cardiac surgery carries a high risk for the fetus. No anticoagulant regimen can be said to be entirely safe for use during pregnancy, as there is a degree of risk with each regimen. Therefore, this review has been done to find appropriate management for women dealing with such conditions.
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Makhija et al. (2022) studied this question.
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