Roos-Hesselink J W, Meijboom F J, Leebeek F W G, de Groot C J M
Erasmus MC-Sophia Kinderziekenhuis, Rotterdam.
Ned Tijdschr Geneeskd. 2007 Feb 17;151(7):389-94.
Two pregnant women aged 32 and 34, both of whom had mechanical prosthetic mitral valves, for which they were using low molecular weight heparin. One developed orthopnoea and dyspnoea at 36 weeks amenorrhoea, and the other suffered an acute myocardial infarction at 18 weeks. Both had valvular thrombosis. Following effective treatment, both women delivered at term and one week later after an uncomplicated course, were discharged home from hospital. Clinicians caring for pregnantwomen with mechanical prosthetic valves are faced with a dilemma when trying to provide optimal treatment. Inadequate anticoagulant therapy can result in thrombosis of the mechanical prosthetic valve while, on the other hand, anticoagulant therapy is associated with foetal and maternal bleeding and teratogenic effects. Pregnant women with mechanical prosthetic valves should be thoroughly counselled before or shortly after the confirmation of pregnancy regarding the risks associated with available anticoagulant options, allowing them to make an informed decision concerning the best management plan. This is an algorithm for optimal care of these patients.
两名分别为32岁和34岁的孕妇，她们都装有机械人工二尖瓣，并正在使用低分子量肝素。其中一名孕妇在闭经36周时出现端坐呼吸和呼吸困难，另一名在18周时发生急性心肌梗死。两人均有瓣膜血栓形成。经过有效治疗后，两名孕妇均足月分娩，在经历了一个无并发症的过程后，于一周后出院回家。照顾装有机械人工瓣膜的孕妇的临床医生在试图提供最佳治疗时面临两难境地。抗凝治疗不足可能导致机械人工瓣膜血栓形成，而另一方面，抗凝治疗与胎儿和母体出血以及致畸作用有关。对于装有机械人工瓣膜的孕妇，应在确认怀孕之前或之后不久就与可用抗凝方案相关的风险进行充分咨询，使她们能够就最佳管理计划做出明智的决定。这是针对这些患者的最佳护理算法。
