Risks and pregnancy management in the patients with heart valves prostheses

Abstract

Background: We have performed a systemic review of the literature to determine pooled estimates of maternal and fetal risks associated with 3 commonly used approaches: 1) the administration of oral anticoagulants throughout the pregnancy, 2) replacing oral anticoagulants with heparin in the first trimester of the pregnancy, and 3) the administration of heparin throughout the pregnancy. The prenatal care of women with artificial heart valves remains one of the most complex issues for cardiologists and obstetrician-gynecologists all over the world. Pregnancy and labor of women with artificial heart valves are usually associated with a high risk. During the pregnancy appears not only the risk of the cardiac pathology progression, but also of the manifestation of subclinical running hereditary thrombophilia and/ or antiphospholipid syndrome, in the above mentioned case the risk of thromboembolic episodes pathologies increases manifold. This overview presents the updated data on the ways of administration of anticoagulants that are most frequently used in the obstetric care. It outlines the principles of the rational anticoagulant therapy during the pregnancy and labor of women with artificial heart valves, as well as the laboratory monitoring of the performed treatment. The question of the management of pregnant women with mechanical valve prostheses is quite controversial and there is no universal consensus in this regard. Here there is an increased risk of complications for both mother and fetus: abortion and placental hemorrhage. Conclusions: Anticoagulation in pregnant women is individual. Therefore, the therapy strategy should be adequate to ensure a minimum level of anticoagulation and bleeding complications.