Abstract:
OBJECTIVE : To document maternal and foetal morbidity and
mortality in anticoagulated, pregnant patients with mechanical
heart valves until 42 days postpartum.
METHODS : In a tertiary single-centre, prospective cohort,
178 consecutive patients at the cardiac-obstetric clinic were
screened for warfarin use between 1 July 2010 and 31
December 2015. Of 33 pregnancies identified, 29 were included.
Patients received intravenous unfractionated heparin from
six to 12 weeks’ gestation and peripartum, and warfarin from
12 to 36 weeks. Maternal outcomes including death, major
haemorrhage and thrombosis, and foetal outcomes were
documented.
RESULTS : There were two maternal deaths, five returns to theatre
post-delivery, eight patients transfused, six major haemorrhages,
one case of infective endocarditis and three ischaemic
strokes. Ten pregnancies had poor foetal outcomes (six
miscarriages, three terminations, one early neonatal death).
Twenty patients required more than 30 days’ hospitalisation,
and 15 required three or more admissions. HIV positivity was
associated with surgical delivery (p = 0.0017).
CONCLUSIONS : Complication rates were high despite centralised
care.
