Caruso A, de Carolis S, Ferrazzani S, Paradisi G, Pomini F, Pompei A
Department of Obstetrics and Gynecology, Catholic University of Rome, Italy.
Eur J Obstet Gynecol Reprod Biol. 1994 Mar 31;54(1):7-11. doi: 10.1016/0028-2243(94)90074-4.
Twenty-one pregnancies in 16 women who conceived after cardiac valve replacement were reviewed. Oral anticoagulants were discontinued before conception or as soon as possible for subcutaneous heparin treatment (8000-14,000 IU every 8-12 h) and resumed in the second trimester until the last period of pregnancy when oral anticoagulants were replaced again by heparin. No therapeutic abortion was performed. The spontaneous abortion rate was found to be 14.3% (3/21). Preterm delivery (< or = 37 weeks) and low birth weight babies (< 2500 g) were 29.4% (5/17) and 35.3% (6/17), respectively, significantly more frequent than those of the control group (P < 0.02 and P < 0.0005). No significant statistical difference was found when the rate of spontaneous abortion [14.3% (3/21)] and the rate of fetal growth retardation [11.8% (2/17)] were compared with the control group. The majority of thromboembolic events (6/7) occurred during heparin regimen in three mothers; one of them subsequently died. No coumarin embryopathy was observed and the physical and mental development in the 16 surviving children was good. This study confirms: (1) the increased rate of preterm delivery and infants weighing < 2500 g; (2) the increased risk of maternal thrombosis related to heparin use; and (3) the good follow-up in the surviving children.
对16名心脏瓣膜置换术后怀孕的女性的21次妊娠情况进行了回顾。在受孕前或尽快停用口服抗凝剂，改为皮下注射肝素治疗（每8 - 12小时8000 - 14000国际单位），并在孕中期重新开始使用口服抗凝剂，直至妊娠末期再次用肝素替代口服抗凝剂。未进行治疗性流产。发现自然流产率为14.3%（3/21）。早产（≤37周）和低体重儿（<2500克）的发生率分别为29.4%（5/17）和35.3%（6/17），显著高于对照组（P<0.02和P<0.0005）。当将自然流产率[14.3%（3/21）]和胎儿生长迟缓率[11.8%（2/17）]与对照组进行比较时，未发现显著统计学差异。大多数血栓栓塞事件（6/7）发生在三名母亲使用肝素治疗期间；其中一人随后死亡。未观察到香豆素胚胎病，16名存活儿童的身心发育良好。本研究证实：（1）早产率和体重<2500克婴儿的发生率增加；（2）与使用肝素相关的母亲血栓形成风险增加；（3）存活儿童的随访情况良好。
