Department of Obstetrics, St Michael's Hospital, Bristol, UK.
BJOG. 2012 Jul;119(8):1008-13; discussion 1012-3. doi: 10.1111/j.1471-0528.2012.03359.x. Epub 2012 May 9.
The management of anticoagulation in pregnant women with mechanical heart valves is complex. The maternal and fetal outcomes of 32 pregnancies in 15 women on three different anticoagulation regimens were compared. Anticoagulation with low-molecular-weight heparin (n=4), warfarin (n=22) and combination therapy (n=6) resulted in adverse maternal events in four (100%), three (50%) and three (14%) women, and resulted in fetal losses in one (25%), 17(77%) and three (50%) pregnancies, respectively. Whereas the rate of fetal loss in the warfarin group was high, all women in the LMWH and half of those in the combination group had serious adverse maternal events, including valve thrombosis, maternal death and postpartum haemorrhage.
在患有机械心脏瓣膜的孕妇中，抗凝治疗的管理较为复杂。我们比较了 15 名女性在三种不同抗凝方案下的 32 次妊娠的母婴结局。采用低分子肝素（n=4）、华法林（n=22）和联合治疗（n=6）抗凝的 4 名（100%）、3 名（50%）和 3 名（14%）女性出现了不良母体事件，分别有 1 名（25%）、17 名（77%）和 3 名（50%）胎儿流产。尽管华法林组的胎儿流产率较高，但所有使用低分子肝素的女性和半数使用联合治疗的女性均出现严重的不良母体事件，包括瓣膜血栓形成、母体死亡和产后出血。
