Department of Obstetrics & Gynaecology, Postgraduate Institute of Medical Education & Research, Sector-12, Chandigarh 160012, India.
Eur J Obstet Gynecol Reprod Biol. 2011 Dec;159(2):320-3. doi: 10.1016/j.ejogrb.2011.09.011. Epub 2011 Oct 1.
This study was undertaken to analyze the maternal and perinatal outcome in women with prosthetic heart valves on different anticoagulant regimens.
A retrospective chart review of pregnancies in 40 women with mechanical valve prostheses at a tertiary referral centre from 1997 to 2010. The main outcome measures were major maternal complications and perinatal outcome.
The valves replaced were mitral (67.5%), aortic (15.0%), or both (17.5%). Forty-nine pregnancies (72.1%) resulted in live births, 3(4.4%) had stillbirths, and 13(19.1%) had spontaneous abortions and 1(1.4%) underwent therapeutic abortions. The live birth rate was higher in women on heparin (78.3%) compared with those on warfarin (66.9%). There were 2 maternal deaths due to acute mitral valvular thrombosis while on acenocoumarol in the second trimester. Hemorrhagic complications occurred in 3 patients on heparin in the postpartum period, 2 of whom required transfusion. In addition one patient who was on acenocoumarol developed secondary hemorrhage.
No anticoagulant regimen can be said to be entirely safe for use during pregnancy as there is a degree of risk with each regimen. Further larger studies are needed to come up with sufficient evidence-based recommendations for the best possible management of such patients to reduce the maternal risks after mechanical heart valve replacement without compromising fetal outcome.
本研究旨在分析不同抗凝方案下服用人工心脏瓣膜的女性的母婴结局。
回顾性分析了 1997 年至 2010 年期间，一家三级转诊中心的 40 名患有机械瓣膜假体的女性的妊娠情况。主要观察指标为主要产妇并发症和围产儿结局。
置换的瓣膜分别为二尖瓣（67.5%）、主动脉瓣（15.0%）或两者（17.5%）。49 例（72.1%）妊娠最终分娩活产儿，3 例（4.4%）死胎，13 例（19.1%）自然流产，1 例（1.4%）行人工流产。肝素组（78.3%）的活产率高于华法林组（66.9%）。有 2 例产妇在妊娠中期服用 acenocoumarol 时因急性二尖瓣血栓形成而死亡。肝素组 3 例产妇在产后出现出血并发症，其中 2 例需要输血。此外，1 例服用 acenocoumarol 的患者发生二次出血。
没有一种抗凝方案可以被认为在妊娠期间是完全安全的，因为每种方案都存在一定的风险。需要进一步开展更大规模的研究，为机械心脏瓣膜置换后降低产妇风险而不影响胎儿结局的此类患者提供最佳管理提供足够的循证建议。
