MANAGEMENT OF PREGNANCY IN PATIENTS WITH MECHANICAL PROSTHETIC CARDIAC VALVE AT AIN SHAMS UNIVERSITY MATERNITY HOSPITAL: FIVE - YEAR EXPERIENCE

Abstract

Pregnancy presents a particular challenge for management of anticoagulation in women with MPHV. The physiological changes of pregnancy induce a prothrombotic environment, reinforcing the requirement for effective anticoagulation. This is a retrospective study that comprised 600 pregnant patients with MPHV. They were divided according to their anticoagulant regimen during pregnancy into three groups: (OAC) group who received OAC throughout pregnancy (342), (UFH- OAC) group in which, patients changed OAC to UFH at 5th-6th weeks gestation then rewarfarinized at 12-14 week (208), (LMWH) group in which patients administered LMWH throughout pregnancy (50). The higher incidence of maternal complications reported in (UFH-OAC) group as 17 (8.2%) patients developed thromboembolic complications, 4 (1.9%) of them presented by valve thrombosis. Also the incidence of hemorrhagic complications was found to be higher in (UFH-OAC) group (9.6%) with significant higher rate for blood transfusion (7.5%). It was found that patient's admission to ICU was significant high among the patients belonged to (OAC) group (10.9%) compared to (UFH-OAC) group (8.5%) and 0% in LMWH group. Although warfarin is an easily administered and controllable drug, it carries a higher risk of teratogenicity and overall fetal wastage. As regard, in our study teratogenicity in (OAC) group was (3.8%) which is higher compared to (UFH-OAC) group (1.0%) and (LMWH) group (0%), the highest overall fetal wastage was reported in OAC group (54.7%) than (UFH-OAC) group (20.7%) and (LMWH) group (18%).