Key result
Among pregnant women with cardiac valve replacement, heparin use was associated with significantly higher rates of hematoma formation (22.2%, p=0.011) and transfusion (27.8%, p=0.005).
Why the study?
Does the type of anticoagulation (oral anticoagulants, heparin, or none) affect feto-maternal morbidity and mortality in pregnant women with prior cardiac valve replacement?
Cohort (n=101)
Does the type of anticoagulation (oral anticoagulants, heparin, or none) affect feto-maternal morbidity and mortality in pregnant women with prior cardiac valve replacement?
In pregnant women with cardiac valve replacement, heparin use is associated with higher rates of hematoma and transfusions compared to oral anticoagulants or no anticoagulation, highlighting the need for close monitoring.
May warrant closer peripartum monitoring with heparin; leaves open optimal regimen balancing maternal-fetal risks.
BACKGROUND: The aim of this study is to evaluate the fetomaternal morbidity and mortality of the pregnancies of women who conceived after cardiac valve replacement. METHODS: A consecutive series of one hundred and thirty-six pregnancies of one hundred and one patients who conceived after cardiac valve replacement were retrospectively analyzed. Regarding the anticoagulation therapy, 101 patients were classified into three groups: A: patients on oral anticoagulants (n=68), B: patients on heparin (n=16) and C: patients who received no anticoagulation (n=17). RESULTS: Three groups (patients on oral anticoagulants (A), on heparin (B), patients who received no anticoagulation (C)) were compared in terms of spontaneous abortion (19%, 11%, 5.6%), preterm delivery (14%, 22.3%, 16.6%), maternal mortality (3%, 11.1%, 0%), thromboembolic events (4%, 11.1%, 0%), cardiac failure (6%, 11.1%, 11.1%), atrial fibrillation (9%, 11.1%, 5.6%), antenatal bleeding (9%, 11.1%, 5.6%), delivery route and fetal malformation (5%, 0%, 0%) and no statistically significant differences were detected. In group B, hematoma formation rate (22.2%) (p=0.011) and transfusion rate (27.8%) (p=0.005) were significantly higher. Five cases of congenital anomalies were detected, all belonging to group A, but this tendency was not found to be statistically significant. CONCLUSIONS: Management of pregnancies with prosthetic heart valves require closely monitored anticoagulation, and an obstetrician should be familiar with the potential fetal and maternal adverse effects of any anticoagulant therapy during the course of pregnancy.
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Ayhan et al. (2001) conducted a cohort in Pregnancy after cardiac valve replacement (n=101). Anticoagulation therapy (oral anticoagulants or heparin) vs. No anticoagulation was evaluated on Fetomaternal morbidity and mortality (including spontaneous abortion, preterm delivery, maternal mortality, and thromboembolic events). Among pregnant women with cardiac valve replacement, heparin use was associated with significantly higher rates of hematoma formation (22.2%, p=0.011) and transfusion (27.8%, p=0.005).
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