ANTICOAGULANT-THERAPY IN PREGNANCY - REPORT OF 54 CASES

Background. To investigate the adverse effects of anticoagulant therap y during pregnancy in a tertiary care center. Material and methods. A prospective study was carried out between 1 January 1977 and 31 Decemb er 1994 and included 54 pregnancies in 50 women treated with anticoagu lants. In Group I (n=43) oral anticoagulants were replaced for heparin from the sixth until the end of the twelfth week of gestation. In Gro up II (n=11) the pregnancy was diagnosed after the ninth week of gesta tion and acenocoumarol was not substituted. All patients received vita mine K antagonists during the second and third trimesters. Heparin was given after 36 weeks of pregnancy until the tenth day in the postpart um period. Statistical comparisons used Chi square test (with the Yate s correction when appropriate) and Student 1 test. Results. Mechanical heart valve prosthesis was the most frequent indication (68%). There was one artificial heart valve thrombosis during first trimester in Gr oup I and none in Group II (p=0.45). One spontaneous abortion occurred in each group (p=0.86). Seven cardiac complications (13.7%) occurred during the second and third trimesters. We recorded no thrombotic epis ode of an artificial heart valve after the first trimester of pregnanc y. Hemorrhagic complications occurred in mid pregnancy (one case=2%) a nd during peripartum (eight cases=16%). Two maternal deaths occurred i n the postpartum period, both were linked with the anticoagulant thera py. There was one coumarin embryopathy (Group II: 9%), but no neonatal mortality. Conclusions. (1) Hemorrhagic complications occur among 16% of patients receiving anticoagulant therapy during pregnancy. (2) Del ivery and postpartum are the most critical periods. (C) Acta Obstet Gy necol Scand 1996