Tandukar Alina, Jha Kritika, Aryal Roshan, Paudyal Pooja, Katuwal Neeta, Rawal Suniti Joshi
Department of Obstetrics and Gynecology, Tribhuvan University Teaching Hospital, Maharajgunj, Nepal.
Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Nepal.
Int J Surg Case Rep. 2022 Nov;100:107751. doi: 10.1016/j.ijscr.2022.107751. Epub 2022 Oct 13.
Pregnant women under warfarin for mechanical heart valves can pose a variety of challenges which requires fine tuning of various anticoagulants throughout the pregnancy and in the postpartum period as hemorrhage can lead to maternal and fetal morbidity and mortality.
A 36-year-old woman gravida two, para one at 35 weeks 5 days gestation, with hypothyroidism with mitral valve replacement and tricuspid valve repair due to rheumatic heart disease underwent emergency lower section cesarean section for fetal bradycardia. B-lynch suturing was eventually done to control atonic postpartum hemorrhage. During hospital stay she developed surgical site infection of abdominal skin incision site which was also subsequently managed. Postpartum anticoagulation was started late due to postpartum hemorrhage and finally the patient was discharged on warfarin.
There is always a risk of both thromboembolic and hemorrhagic manifestations in a pregnant woman with a prosthetic heart valve which requires fine tuning of anticoagulants throughout the pregnancy and in the postpartum period. Hemorrhagic manifestation in the form of postpartum hemorrhage is common which can be difficult to manage and also poses a great dilemma in restarting the anticoagulation after delivery. Excessive blood loss can itself lead to mortality and morbidity, and also via increased risk of surgical site infection.
Appropriate preconception counseling along with meticulous assessment, management and monitoring of pregnant women with prosthetic heart valves is necessary to decrease fetal and maternal morbidity and mortality.
服用华法林的机械心脏瓣膜置换术后孕妇会面临各种挑战，这需要在整个孕期及产后对各种抗凝剂进行精细调整，因为出血可能导致母婴发病和死亡。
一名36岁女性，孕2产1，妊娠35周5天，因风湿性心脏病行二尖瓣置换术及三尖瓣修复术，合并甲状腺功能减退，因胎儿心动过缓行急诊下段剖宫产术。最终采用B-Lynch缝合控制产后宫缩乏力性出血。住院期间，她出现腹部皮肤切口部位手术部位感染，随后也得到了处理。由于产后出血，产后抗凝治疗开始较晚，最终患者出院时继续服用华法林。
人工心脏瓣膜置换术后孕妇始终存在血栓栓塞和出血表现的风险，这需要在整个孕期及产后对抗凝剂进行精细调整。产后出血形式的出血表现很常见，可能难以处理，并且在分娩后重新开始抗凝治疗时也会带来很大的困境。失血过多本身会导致死亡和发病，还会增加手术部位感染的风险。
对于人工心脏瓣膜置换术后孕妇，进行适当的孕前咨询以及细致的评估、管理和监测，对于降低母婴发病率和死亡率是必要的。
