Mbaye M, Moreira P-M, Guèye S M K, Cissé C T, Moreau J-C, Kane A, Diao M
Clinique gynécologique et obstétricale, université Cheikhe-Anta-Diop, CHU Aristide-le-Dantec, BP 3001, Dakar, Sénégal.
J Gynecol Obstet Biol Reprod (Paris). 2009 Feb;38(1):83-8. doi: 10.1016/j.jgyn.2008.09.007. Epub 2008 Oct 30.
The persistence of the rheumatic valvular cardiopathie and the access to cardiac surgery make this association frequent. This work will deal with a description of the epidemiological and clinic profile and the evaluation of the cares to the pregnancies with cardiac valvular prostheses.
We took a retrospective study beginning from 1987 to 2006 about 14 cases, which had benefited from collaboration between the Gynaecologic and Obstetric Clinic and the Cardiological Clinic of the University Hospital Center of Dakar.
The frequency of pregnancies with valvular prosthesis was of 0.12 per thousand. The average age of our patients was of 27.7 years. The average pregnancy was of 2.3 gestures with extremes of 1st to 12th gestures. The pregnancies were not, in any case, planned. An auricular fibrillation was noticed in four patients. The fraction of ejection of the left ventricle was superior or equal to 60% in 10 cases, the prosthesis was lightly blocked in two cases. Despite the use of anti-vitamin K during the first trimester with 42.86% of the patients, the anticoagulation was effective with the entire cases excepted one who died by lung embolism. The delivery was, in seven cases, realized by caesarean and in two cases by natural way. Two cases of premature and foetal hypotrophy have been noticed. There was no case of malformed children.
With a multidisciplinary care, the carry of valvular prosthesis can be compatible with pregnancy. The lack of embryopathy and malformed children could incite to propose the oral anticoagulation during the whole sequence of pregnancy.
风湿性心脏瓣膜病的持续存在以及心脏手术的可及性使得这种关联很常见。本研究将描述流行病学和临床特征，并评估对心脏瓣膜置换术后妊娠的护理情况。
我们进行了一项回顾性研究，研究对象为1987年至2006年间的14例患者，这些患者受益于达喀尔大学医院中心妇产科诊所和心脏病科诊所的合作。
心脏瓣膜置换术后妊娠的发生率为千分之0.12。我们患者的平均年龄为27.7岁。平均妊娠次数为2.3次，范围从第1次到第12次。这些妊娠在任何情况下都不是计划内的。4例患者出现房颤。10例患者左心室射血分数大于或等于60%，2例患者瓣膜轻度狭窄。尽管42.86%的患者在孕早期使用了维生素K拮抗剂，但除1例死于肺栓塞外，所有患者的抗凝治疗均有效。7例患者通过剖宫产分娩，2例自然分娩。发现2例早产和胎儿发育迟缓。没有畸形儿童的病例。
通过多学科护理，心脏瓣膜置换术后可以妊娠。未发现胚胎病和畸形儿童，这可能促使在整个孕期都进行口服抗凝治疗。
