Key result
Two pregnant patients with Starr-Edwards mitral valve replacements on oral anticoagulants successfully delivered live babies, suggesting oral anticoagulation can be continued until labour onset.
Why the study?
Does a specific peripartum anticoagulant management strategy result in successful delivery in pregnant patients with prosthetic heart valves?
Case Report (n=2)
Does a specific peripartum anticoagulant management strategy result in successful delivery in pregnant patients with prosthetic heart valves?
Answers are grounded in this paper and cite their sources.
This report outlines a peripartum anticoagulation management strategy for pregnant women with mechanical prosthetic valves to facilitate successful delivery.
We describe two patients with Starr-Edwards mitral valve replacements who underwent pregnancy on oral anticoagulants and who were successfully delivered of live babies. The literature on pregnancy with prosthetic heart valves is reviewed. It is suggested that properly controlled oral anticoagulation should be continued until the onset of labour; the anticoagulant effect should then be reversed by an intravenous infusion of fresh-frozen plasma and the patient maintained on intravenous heparin injections six-hourly. Oral anticoagulants should be restarted immediately after delivery and the heparin withdrawn only when their effect has been re-established.
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Jenkins et al. (1971) conducted a case report in Pregnancy in patients with prosthetic heart valves (n=2). Oral anticoagulants continued until onset of labour, reversed with fresh-frozen plasma, and maintained on IV heparin was evaluated on Successful delivery of live babies. Two pregnant patients with Starr-Edwards mitral valve replacements on oral anticoagulants successfully delivered live babies, suggesting oral anticoagulation can be continued until labour onset.
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