PREGNANCY OUTCOME IN WOMEN WITH CARDIAC-VALVE PROSTHESIS

Twenty-one pregnancies in 16 women who conceived after cardiac valve r eplacement were reviewed. Oral anticoagulants were discontinued before conception or as soon as possible for subcutaneous heparin treatment (8000-14000 IU every 8-12 h) and resumed in the second trimester until the last period of pregnancy when oral anticoagulants were replaced a gain by heparin. No therapeutic abortion was performed. The spontaneou s abortion rate was found to be 14.3% (3/21). Preterm delivery (less t han or equal to 37 weeks) and low birth weight babies (< 2500 g) were 29.4% (5/17) and 35.3% (6/17), respectively, significantly more freque nt than those of the control group (P < 0.02 and P < 0.0005). No signi ficant statistical difference was found when the rate of spontaneous a bortion 14.3% (3/21) and the rate of fetal growth retardation 11.8% (2/17) were compared with the control group. The majority of thrombo embolic events (6/7) occurred during heparin regimen in three mothers; one of them subsequently died. No coumarin embryopathy was observed a nd the physical and mental development in the 16 surviving children wa s good. This study confirms: (1) the increased rate of preterm deliver y and infants weighing < 2500 g; (2) the increased risk of maternal th rombosis related to heparin use; and (3) the good follow-up in the sur viving children.