Pregnancy in women with mechanical valve prosthesis is dangerous mainly because of problems originating from oral anticoagulants. Warfarin derivatives, necessary for thromboembolism prevention and avoidance of maternal mortality, have a teratogenic and hemorrhagic effect upon the fetus reflected in a high fetal mortality. Avoidance of oral anticoagulants should result in a normal or nearly normal course of pregnancy in women with prosthetic cardiac valves.
Twenty female subjects with bioprosthetic valve replacement were treated with aspirin as the only antithrombotic drug. This is the largest series of pregnant women with bioprostheses reported in the literature.
Material and Methods
From April, 1976 to May, 1982, 20 women with implanted bioprostheses were admitted into the Obstetric Department of Ciudad Sanitaria “I^a Paz,” Madrid. Patient ages ranged from 22 to 36 years, mean age 26.8 years. Isolated aortic valve replacement was presented six times (four Carpentier-Edwards and two Hancock); mitral valve replacement, seven times (four Carpentier-Edwards and three Hancock); and aortic plus mitral, seven patients (five Carpen-tier-Edwards and two Hancock). Valve replacement was performed originally for advanced rheumatic valve disease in 14 patients: class 3 (12 cases), class 4 (2 cases) of the NYHA classification. Four patients had aortic valve replacement for bacterial endocarditis and two for annuloaortic ectasia (Bentall and Bonno operation). All patients were in class 1-2 of the NYHA classification when they conceived. Thirteen women had atrial fibrillation throughout pregnancy. See more info about pregnancy on Canadian Health&Care Mall using http://healthcaremall4you.com/pregnancy-is-a-long-period-of-happiness.html.
All patients were receiving platelet antiaggregants (aspirin) throughout pregnancy, delivery, and after the delivery period. Women were given 1 g of aspirin every day (11 women) or 500 mg every 48 hours (nine women).
Preoperative Obstetric History
Eight women had 12 pregnancies prior to the cardiac valve replacement operation. One pregnancy and vitamins for them ordered via Canadian Health&Care Mall ended in early abortion. Eleven pregnancies ended in normal vaginal deliveries. All babies were full term infants. There were no Caesarean sections, instrumental deliveries, or preterm or dysmature infants.
Postoperative Obstetric History
The 20 patients had 27 pregnancies after cardiac valve replacement. Three of them ended in early abortions of unknown etiology. There were no anatomic reports of the fetuses. All 24 deliveries were vaginal, one of them a forceps delivery. Twenty-five healthy babies were born (one twin pregnancy). One baby was born preterm. There were no infants small for gestational age or abnormal.
There was no maternal mortality or morbidity from the point of view of thromboembolism or hemorrhage. All patients tolerated well the hemodynamic overload of pregnancy, being in class 1 or 2 (NYHA classification) during the pregnancy period.
Pregnancy complications for the 20 women were compared with their obstetric histories prior to valve replacement and with the memorandum of the Obstetrical Department of our hospital (years 1975 to 1980) (Table 1).
Table 1—Comparability: Preoperative to Postoperative; General Statistics, Obstetric Department (GSOD)
|Before Valve After Valve Replacement ReplacementNo. Patients 8 20
Pregnancies 12 (100) 27 (100)
|GSOD102.126 124.778 (100)|
|Abortions 1 (8) 3 (11)||18.753 (13)|
|Vaginal del 11 (100) 24 (100)||94.582 (90)|
|Caesarian sec 0 (0) 0 (0)||4.996(4)|
|Instrumental del 0 (0) 1 (4.5)||6.447 (6)|
|Born infants 11(100) 25(100)||126.021 (100)|
|Fullterm 11 (100) 24 (96)||120.619 (95.7)|
|Preterm 0 (0) 1 (4)||5.402 (4.3)|
|Small for gestational age 0 (0) 0 (0)||4.536 (3.6)|
|Malformed 0 (0) 0 (0)||313 (0.23)|
|Neonatal mort 0 (0) 0 (0)||1.032 (0.8)|
|Mother mort 0 (0) 0 (0) (% pregnancies)||54 (0.037)|