Pregnancy outcome in women with prosthetic heart valves

Objective: to investigate the outcomes of pregnancy and delivery in patients with prosthetic heart valves as well as to assess the fetal and neonatal outcomes. study design: descriptive observational study. place & duration of study: the gynaecology & obstetrics department of armed forces institute of cardiology rawalpindi from august 2009-january 2012. material and methods: 38 pregnancies with prosthetic heart valves were selected according to inclusion / exclusion criteria by convenience sampling. detailed counselling and individualized decision making was carried out and they were divided among three groups according to the different anticoagulation regimes. relevant data was obtained and outcomes of pregnancy like miscarriages,termination of pregnancy,type of delivery,adverse haemodynamic events during pregnancy,labour or puerperium,maternal deaths and fetal and neonatal outcomes were studied. results: we had metallic valves inserted in 34/38(89.47%) of the pregnancies and bioprosthetic valves in 4/38(10.52%). mean age and parity were27.95±4.32 years and 1.74±1.23 respectively. fetal attrition occurred in3/38(7.89%),3/38(7.89%) and 1/38(2.63%) in the first,second and the third trimester respectively. we had 5/31(16.12%) premature births,caesarean section in 13/31(41.93%) and 18/31(58.06%) vaginal deliveries. adverse haemodynamic events and maternal deaths occurred in6/38 (15.78%) and 4/38 (10.52%) of pregnancies respectively,mostly in the groups 1 and 3. we had a generally good neonatal outcome with no case of warfarin embryopathy. conclusion: there was generally good maternal and neonatal outcome in patients with good nyha functional class. warfarin may be continued throughout pregnancy for these patients. maternal deaths and adverse haemodynamic events could be reduced by better education,counselling and compliance with care.