Pregnancy after mechanical mitral valve replacement

Abstract EN

Background : Pregnant patients with mechanical heart valves require anticoagulation.

The risk of bleeding and embryopathy associated with oral anticoagulation must be weighed against the risk of valve thrombosis. Objectives : This study attempted to find the fatal outcome between warfarin and heparin regiments throughout pregnancy. Patients and Methods : In this prospective study undertaken between 1999 and 2009, 53 pregnancies (47 women with mechanical mitral valve ; 29.8 ± 4.8 years old) were studied.

Patients were divided in two groups, group I (n = 43) took warfarin throughout the pregnancy while, group II (n = 10) received heparin in the first trimester and after took warfarin that until 36 weeks. Results : Thirty-two pregnancies (60.4 %) resulted in live births while 18(34 %) abortions, 2 (3.8 %) still births and one (1.9 %) maternal death occurred.

In group I, there were 26 live births (60.5 %), one still birth (2.3 %) and 15 (34.9 %) abortions.

In group II there were 6 (60 %) live births, one (10 %) still birth and 3(30%) abortions.

There were no significant differences between two groups in fetal outcome.

Thirty –Nine (90.7 %) pregnancies in group I and in groups II 50 % (P = 0.001) occurred without complication .There were no congenital malformations in two groups. Conclusions : Fetal outcome was almost same between warfarin and heparin regimens.

In maternal outcome, warfarin regimen is safer than heparin.