Management of pregnant women with cardiac diseases at potential risk of thromboembolism — Experience and review

Abstract Over a 7-year period, the chart records of six pregnant women with cardiac diseases at potential risk of thromboembolism were reviewed. All six patients survived and recovered well eventually. LMWH and beta-adrenergic blocker were effective to deal with atrial fibrillation. Digitalis and do...

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Bibliographic Details
Published in:International journal of cardiology 2009-08, Vol.136 (2), p.229-232
Main Author: Cho, Fu-Nan
Format: Article
Language:English
Subjects:
Anticoagulants - therapeutic use
Anticoagulation
Atrial fibrillation
Cardiomyopathy
Cardiovascular
Female
Heart Diseases - drug therapy
Heart Diseases - epidemiology
Humans
Low molecular weight heparin
Mechanical mitral valve
Pregnancy
Pregnancy Complications, Hematologic - epidemiology
Pregnancy Complications, Hematologic - prevention & control
Risk Factors
Thromboembolism - epidemiology
Thromboembolism - prevention & control
Warfarin
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Summary:Abstract Over a 7-year period, the chart records of six pregnant women with cardiac diseases at potential risk of thromboembolism were reviewed. All six patients survived and recovered well eventually. LMWH and beta-adrenergic blocker were effective to deal with atrial fibrillation. Digitalis and dobutamine were beneficial to prevent heart failure resulted from degenerated porcine valve and dilated cardiomyopathy. In a patient with mechanical mitral valve, low-dose warfarin did not cause fetal malformation, and was effective to prevent thrombus formation. Protamine sulfate was safely administered to neutralize intravenous heparin effect before vaginal delivery. Life-threatening postpartum pulmonary hemorrhage occurred as a result of pulmonary hypertension with an aberrant right pulmonary artery, absolutely necessitating a long-term cardiopulmonary bypass resuscitation. Patient with primary pulmonary hypertension gave birth safely with forceps assistance under epidural anesthesia. From literatures reviewed and successful experiences presented here, prenatal correction of the underlying cardiac malformation, precise switch of anticoagulant administration, optimizing cardiac function, early delivery prior to heart failure, postpartum fluid restriction, minimized peripartum blood loss, and meticulously intensive cares are essential to achieve satisfactory outcomes.
ISSN:0167-5273
1874-1754
DOI:10.1016/j.ijcard.2008.04.037