Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular Center, 6-1, Kishibeshinmachi, Suita City, Osaka Prefecture, Japan.
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1, Kishibeshinmachi, Suita City, Osaka Prefecture, Japan.
Gen Thorac Cardiovasc Surg. 2021 Mar;69(3):550-554. doi: 10.1007/s11748-020-01494-0. Epub 2020 Sep 27.
Pregnancy with a mechanical heart valve (MHV) is high risk for valve thrombosis because pregnancy is a hyper-coagulation state. In addition, warfarin use during pregnancy is restricted due to its fetotoxicity, and postpartum bleeding may be increased with anticoagulation. In particular, placenta previa under anticoagulation may cause massive postpartum bleeding. The optimal anticoagulation for a pregnant woman with mitral and aortic double MHVs is not known. In addition, suitable techniques for control of bleeding in a case of placenta previa under anticoagulation are not known. Thus, a case of a pregnant woman with mitral and aortic double MHVs and placenta previa is presented. The case was managed without valve thrombosis through precise unfractionated heparin dose adjustment and frequent activated partial thromboplastin time monitoring, along with maintenance of antithrombin levels. Compression sutures were found to be effective for controlling bleeding from the attachment site of placenta previa even under anticoagulation.
患有机械心脏瓣膜 (MHV) 的孕妇存在瓣膜血栓形成的高风险，因为妊娠是一种高凝状态。此外，由于华法林的致畸性，妊娠期间使用华法林受到限制，并且抗凝可能会增加产后出血。特别是在抗凝的情况下，前置胎盘可能会导致大量产后出血。患有二尖瓣和主动脉双 MHV 的孕妇的最佳抗凝方法尚不清楚。此外，对于抗凝下前置胎盘的出血控制的合适技术也尚不清楚。因此，报告了一例患有二尖瓣和主动脉双 MHV 以及前置胎盘的孕妇病例。通过精确调整未分级肝素剂量和频繁监测活化部分凝血活酶时间，同时维持抗凝血酶水平，该病例在没有发生瓣膜血栓形成的情况下得到了控制。即使在抗凝的情况下，压迫缝线对于控制前置胎盘附着部位的出血也很有效。
