What question did this study set out to answer?

Evaluate maternal, obstetric, and neonatal outcomes and complication rates associated with pregnancy and anticoagulation regimens in women with prosthetic heart valves.

January 28, 2011European Journal of Cardio-Thoracic SurgeryOpen Access

Pregnancy with prosthetic heart valves — 30 years’ nationwide experience in Denmark☆☆☆

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Why the study?

What are the maternal and fetal outcomes and complications in women with prosthetic heart valves during pregnancy compared to healthy pregnant women?

Population

79 women between 15 and 40 years of age with 155 pregnancies after prosthetic heart valve replacement.

Comparison

Pregnancy with prosthetic heart valves and… vs Age-adjusted selected population of healthy…

Design

Cohort

Follow-up

30 years (1977 to 2007)

Authors

MSMartin SillesenRigshospitalet VHVibeke E. HjortdalPediatric / Congenital Cardiology NVNiels VejlstrupAdult Congenital Heart Disease

Discussion

Member takes

Implication

Supports intensified monitoring in prosthetic valve pregnancies; leaves open whether valve type or anticoagulation drives excess risks.

Key Points

Evaluate maternal, obstetric, and neonatal outcomes and complication rates associated with pregnancy and anticoagulation regimens in women with prosthetic heart valves.
Conducted a nationwide registry cohort study analyzing cardiac, obstetric, and neonatal data from 1977 to 2007, corroborated by questionnaires.
Assessed 155 pregnancies in 79 women (out of 356 women aged 15–40 with valve replacements) and compared outcomes across study decades and against an age-adjusted healthy pregnant control cohort.
Maternal complications included 2 deaths (one from heart failure, one from postpartum bleeding) and 4 thromboembolic episodes; postpartum hemorrhage occurred significantly more often in patients than controls (p=0.0021).
Patients had higher rates of early miscarriage (34% vs 20%, p=0.0036), terminations (26% vs 13%, p=0.000019), and cesarean delivery (55% vs 16%, p=0.000000000097) in the last decade.
Adverse neonatal outcomes were elevated among patients, including premature birth (49% vs 5.5%, p=0.00000000039) and congenital malformations (14% vs 5.7%, p=0.044), with warfarin embryopathy affecting 8% of first-trimester exposures.

Structured PICO

What are the maternal and fetal outcomes and complications in women with prosthetic heart valves during pregnancy compared to healthy pregnant women?

Population

79 women between 15 and 40 years of age with 155 pregnancies after prosthetic heart valve replacement.

Intervention

Pregnancy with prosthetic heart valves and associated anticoagulation regimens (including unfractionated heparin and warfarin).

Comparator

Age-adjusted selected population of healthy, pregnant women (general female population data).

Outcome

Maternal and fetal outcomes including mortality, thrombo-embolic episodes, miscarriages, terminations, post-partum bleeding, cesarean section, premature births, and congenital malformations.hard clinical

Women with prosthetic heart valves tolerate pregnancy relatively well but face significantly higher risks of miscarriages, premature births, congenital malformations, and anticoagulation-related complications compared to healthy women.

Cite This Study

Sillesen et al. (2011) studied this question.

synapsesocial.com/papers/6a825f56004fcf503374ae70 https://doi.org/10.1016/j.ejcts.2010.12.011

Topics

Valvular heart disease

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Pregnancy with prosthetic heart valves — 30 years’ nationwide experience in Denmark☆☆☆

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Pregnancy with prosthetic heart valves — 30 years’ nationwide experience in Denmark☆☆☆

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider