PMID- 26884686
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20160217
LR  - 20200930
IS  - 1179-5468 (Print)
IS  - 1179-5468 (Electronic)
IS  - 1179-5468 (Linking)
VI  - 10
DP  - 2016
TI  - Maternal and Fetal Outcomes in Pregnant Women with a Prosthetic Mechanical Heart 
      Valve.
PG  - 11-7
LID - 10.4137/CMC.S36740 [doi]
AB  - BACKGROUND: Pregnancy is associated with several cardiocirculatory changes that 
      can significantly impact underlying cardiac disease. These changes include an 
      increase in cardiac output, sodium, and water retention leading to blood volume 
      expansion, and reductions in systemic vascular resistance and systemic blood 
      pressure. In addition, pregnancy results in a hypercoagulable state that 
      increases the risk of thromboembolic complications. OBJECTIVES: The aim of this 
      study is to assess the maternal and fetal outcomes of pregnant women with 
      mechanical prosthetic heart valves (PHVs). METHODS: This is a prospective 
      observational study that included 100 pregnant patients with cardiac mechanical 
      valve prostheses on anticoagulant therapy. The main maternal outcomes included 
      thromboembolic or hemorrhagic complications, prosthetic valve thrombosis, and 
      acute decompensated heart failure. Fetal outcomes included miscarriage, fetal 
      death, live birth, small-for-gestational age, and warfarin embryopathy. The 
      relationship between the following were observed: - Maternal and fetal 
      complications and the site of the replaced valve (mitral, aortic, or double)- 
      Maternal and fetal complications and warfarin dosage (</=5 mg, >5 mg)- Maternal and 
      fetal complications and the type of anticoagulation administered during the first 
      trimester. RESULTS: This study included 60 patients (60%) with mitral valve 
      replacement (MVR), 22 patients (22%) with aortic valve replacement (AVR), and 18 
      patients (18%) with double valve replacement (DVR). A total of 65 patients (65%) 
      received >5 mg of oral anticoagulant (warfarin), 33 patients (33%) received </=5 mg 
      of warfarin, and 2 patients (2%) received low-molecular-weight heparin (LMWH; 
      enoxaparin sodium) throughout the pregnancy. A total of 17 patients (17%) 
      received oral anticoagulant (warfarin) during the first trimester: 9 patients 
      received a daily warfarin dose of >5 mg while the remaining 8 patients received a 
      daily dose of </=5 mg. Twenty-eight patients (28%) received subcutaneous (SC) 
      heparin calcium and 53 patients (53%) received SC LMWH (enoxaparin sodium). 
      Prosthetic valve thrombosis occurred more frequently in patients with MVR (P = 
      0.008). Postpartum hemorrhage was more common in patients with aortic valve 
      prostheses than in patients with mitral valve prostheses (P = 0.005). The 
      incidence of perinatal death was higher in patients with AVR (P = 0.014). The 
      incidence of live birth was higher in patients with DVR (P = 0.012). The 
      incidence of postpartum hemorrhage was higher in patients who received a daily 
      dose of >5 mg of warfarin than in patients who received </=5 mg of warfarin (P = 
      0.05). The incidence of spontaneous abortion was also higher in patients 
      receiving >5 mg of warfarin (P </= 0.001), while the incidence of live births was 
      higher in patients receiving </=5 mg of warfarin (P = 0.008). There was a 
      statistically significant difference between the anticoagulant received during 
      the first trimester and cardiac outcomes. Specifically, patients on heparin 
      developed more heart failure (P = 0.008), arrhythmias (P = 0.008), and 
      endocarditis (P = 0.016). There was a statistically significant relationship 
      between heparin shifts during the first trimester and spontaneous abortion (P = 
      0.003). CONCLUSION: Warfarin use during the first trimester is safer for the 
      mother but is associated with more fetal loss, especially in doses that exceed 5 
      mg. The incidence of maternal complications is greater in women who receive LMWH 
      or unfractionated heparin during the first trimester, especially prosthetic valve 
      thrombosis, although the fetal outcome is better because heparin does not cross 
      the placenta.
FAU - Ayad, Sherif W
AU  - Ayad SW
AD  - Faculty of Medicine, Alexandria University, Alexandria, Egypt.
FAU - Hassanein, Mahmoud M
AU  - Hassanein MM
AD  - Faculty of Medicine, Alexandria University, Alexandria, Egypt.
FAU - Mohamed, Elsayed A
AU  - Mohamed EA
AD  - Faculty of Medicine, Alexandria University, Alexandria, Egypt.
FAU - Gohar, Ahmed M
AU  - Gohar AM
AD  - Faculty of Medicine, Alexandria University, Alexandria, Egypt.
LA  - eng
PT  - Journal Article
DEP - 20160210
PL  - United States
TA  - Clin Med Insights Cardiol
JT  - Clinical Medicine Insights. Cardiology
JID - 101525768
PMC - PMC4750893
OTO - NOTNLM
OT  - mechanical heart valve
OT  - pregnancy
EDAT- 2016/02/18 06:00
MHDA- 2016/02/18 06:01
PMCR- 2016/02/10
CRDT- 2016/02/18 06:00
PHST- 2015/10/21 00:00 [received]
PHST- 2015/12/28 00:00 [revised]
PHST- 2016/01/02 00:00 [accepted]
PHST- 2016/02/18 06:00 [entrez]
PHST- 2016/02/18 06:00 [pubmed]
PHST- 2016/02/18 06:01 [medline]
PHST- 2016/02/10 00:00 [pmc-release]
AID - cmc-10-2016-011 [pii]
AID - 10.4137/CMC.S36740 [doi]
PST - epublish
SO  - Clin Med Insights Cardiol. 2016 Feb 10;10:11-7. doi: 10.4137/CMC.S36740. 
      eCollection 2016.