Successful management of postpartum hemorrhage and surgical site infection in a pregnant woman under warfarin for heart valve replacement: A case report

• Published in: International journal of surgery case reports 2022-11, Vol.100, p.107751, Article 107751
• Main Authors: Tandukar, Alina, Jha, Kritika, Aryal, Roshan, Paudyal, Pooja, Katuwal, Neeta, Rawal, Suniti Joshi
• Format: Article
• Language: English
• Subjects: Case Report; Heart valve replacement; Postpartum hemorrhage; Surgical site infection; Warfarin
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2022.107751

Pregnant women under warfarin for mechanical heart valves can pose a variety of challenges which requires fine tuning of various anticoagulants throughout the pregnancy and in the postpartum period as hemorrhage can lead to maternal and fetal morbidity and mortality. A 36-year-old woman gravida two, para one at 35 weeks 5 days gestation, with hypothyroidism with mitral valve replacement and tricuspid valve repair due to rheumatic heart disease underwent emergency lower section cesarean section for fetal bradycardia. B-lynch suturing was eventually done to control atonic postpartum hemorrhage. During hospital stay she developed surgical site infection of abdominal skin incision site which was also subsequently managed. Postpartum anticoagulation was started late due to postpartum hemorrhage and finally the patient was discharged on warfarin. There is always a risk of both thromboembolic and hemorrhagic manifestations in a pregnant woman with a prosthetic heart valve which requires fine tuning of anticoagulants throughout the pregnancy and in the postpartum period. Hemorrhagic manifestation in the form of postpartum hemorrhage is common which can be difficult to manage and also poses a great dilemma in restarting the anticoagulation after delivery. Excessive blood loss can itself lead to mortality and morbidity, and also via increased risk of surgical site infection. Appropriate preconception counseling along with meticulous assessment, management and monitoring of pregnant women with prosthetic heart valves is necessary to decrease fetal and maternal morbidity and mortality. •Pregnancy with prosthetic heart valves is increasing, which can be associated with thromboembolic and hemorrhagic complications•Postpartum hemorrhage is a common hemorrhagic manifestation with more incidence as compared to unselected obstetric populations•Control of hemorrhage can be difficult which might require surgical intervention•Severe blood loss can also predispose to surgical site infection•Proper reintroduction of anticoagulants in postpartum period is also challenging