Maternal Health Outcomes in Nepalese Women After Mitral Valve Replacement

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Rheumatic heart disease post-mitral valve replacement in pregnancy (n=380). Intervention: Pregnancy post-mitral valve replacement with anticoagulation. Primary outcome: Maternal health outcomes and pregnancy-related complications.

Q: What does this research mean for the field?

In women undergoing pregnancy following mitral valve replacement on anticoagulation, maternal mortality and thromboembolic events are low, but bleeding complications and elective termination rates are high. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

D Joshi; Anushruti Shrestha; Smriti Mahaju Bajracharya; Apurb Sharma

doi:10.33314/jnhrc.v24i01.4765

August 3, 2026Journal of Nepal Health Research CouncilOpen Access

Maternal Health Outcomes in Nepalese Women After Mitral Valve Replacement

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Key result

Anticoagulation in pregnancy post-mitral valve replacement avoids thromboembolism despite a ~28% bleeding rate.

n=380

Why the study?

The effects of anticoagulation on maternal health and pregnancy outcomes in patients with prosthetic mitral valves remain understudied, particularly in low-resource settings.

Key Points

To evaluate maternal health, pregnancy-related complications, coagulation events, maternal mortality, and fetal outcomes among women of reproductive age following mitral valve replacement.
Exploratory retrospective study of female patients of reproductive age who underwent mitral valve replacement between 2017 and 2020 at a hospital in Nepal.
Outcomes were evaluated via hospital medical records review and a single cross-sectional telephone survey conducted from June to August 2023 (N=380 respondents from 474 eligible patients; mean age 31.72±14.28 years; follow-up 4 to 6 years).
Among 380 respondents, 18 post-replacement pregnancies (4.73%) were reported; all patients received anticoagulation (predominantly a warfarin-to-heparin regimen), resulting in 0 maternal deaths and 0 thromboembolic events.
Maternal complications included bleeding in 5 of 18 pregnancies (27.8%) and heart failure in 1 patient (5.5%) with a left ventricular ejection fraction of 35%.
Pregnancy outcomes comprised 7 live births (38.8%; 6 elective cesarean sections, 1 vaginal delivery), 7 elective terminations (39%), 2 spontaneous abortions (11%), 1 intrauterine fetal death (5.5%), and 1 ongoing pregnancy.

Study Design

Type

Cohort (n=380)

Multicenter

No

Structured PICO

P

Population

380 women of childbearing age in Nepal who underwent mitral valve replacement, among whom 18 pregnancies occurred, evaluated for maternal and fetal outcomes after 4 to 6 years of follow-up.

E

Exposure

Anticoagulation therapy during pregnancy (predominantly a warfarin-to-heparin regimen) with medical supervision.

O

Outcome

Maternal health post-MVR, pregnancy-related complications, maternal mortality, coagulation issues, and fetal and neonatal outcomessafety

Limitations

Small number of observed pregnancies limits statistical power to detect less common maternal complications.
Single cross-sectional telephone follow-up introduces recall and selection bias.
High proportion of pregnancies resulted in elective termination but reasons were not systematically explored.
Retrospective design limited the availability of detailed clinical variables including exact anticoagulation adherence.
Small number of observed pregnancies limits the statistical power to detect less common maternal complications and restricts generalizability
Single cross-sectional telephone follow-up introduces recall and selection bias
High proportion of elective terminations without systematic exploration of the underlying reasons
Retrospective design and reliance on existing records limited the availability of detailed clinical variables, including anticoagulation adherence and socioeconomic factors

Implication

Pregnancy in Nepalese women following mitral valve replacement is achievable but associated with a high rate of elective terminations and significant bleeding risks, underscoring the need for tailored preconception counseling.

Abstract

BACKGROUND: The effects of anticoagulation on maternal health in patients with prosthetic valves remain understudied. Our study aims to assess maternal health post-mitral valve replacement (MVR), pregnancy-related complications, maternal mortality, coagulation issues, and fetal and neonatal outcomes post-MVR. METHODS: This exploratory retrospective study, conducted from 2017-2020, included female patients of reproductive age who underwent MVR. Eligible participants were identified from hospital records, and pregnancy-related maternal outcomes were ascertained through review of medical records and a single cross-sectional telephone follow-up conducted between June and August 2023. Data on childbirth, abortion, anticoagulation management, and related complications were collected. Descriptive statistics were used for analysis. RESULTS: Of 474 female patients of childbearing age who underwent MVR, 380 responded to our survey. Of these, 18 cases (4.73%) involved pregnancy post-MVR. All pregnant patients were on anticoagulant therapy during pregnancy, with no maternal deaths reported. However, one patient experienced heart failure post-delivery. Bleeding was the most common complication, occurring in 5/18 pregnancies (27.7%). Seven pregnancies resulted in live births (38.8%), with one low birth weight infant. There were no congenital anomalies, but there was one intrauterine fetal death at 7 months and 2 spontaneous abortions. Seven pregnancies were electively terminated, though the reasons were not studied. One pregnancy was ongoing at the time of the study. All but one delivery occurred under medical supervision, with most patients following a warfarin-to-heparin regimen. CONCLUSIONS: In this cohort, 4.73% of women experienced pregnancies post-MVR, with anticoagulation posing significant challenges. The low rate of maternal and fetal complications suggests a need for further research, particularly regarding the high rate of elective terminations.

Discussion

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Cite This Study

Joshi et al. (2026) conducted a cohort in Rheumatic heart disease post-mitral valve replacement in pregnancy (n=380). Pregnancy post-mitral valve replacement with anticoagulation was evaluated on Maternal health outcomes and pregnancy-related complications. Among 18 pregnancies in women post-mitral valve replacement on anticoagulation, there were no maternal deaths or thromboembolic events, but a 27.8% incidence of bleeding and 39% elective terminations.

synapsesocial.com/papers/6ad0fc7415427f6a8404013f https://doi.org/10.33314/jnhrc.v24i01.4765

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Maternal Health Outcomes in Nepalese Women After Mitral Valve Replacement

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Maternal Health Outcomes in Nepalese Women After Mitral Valve Replacement

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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