Pregnancy with Previous Mitral Valve Replacement

Abstract

Mitral valve replacement has changed many lives of patients with severe mitral stenosis who were doomed due to severe haemodynamic complications. Successful pregnancy outcomes are now numerous. The study was carried out at Services hospital involving 7 pregnant patients with mitral valve replacement, as regards to its antepartum, intrapartum and postpartum management. The study showed the incidence to be 0.2% of all deliveries. Starr- Edwards was the most common (71.5%) prosthetic valve with good haemodynamic outcomes. Five (71.5%) patients remained in NYHA class II, showing the efficacy of valvular surgery and I. Five (71.5%) patients ended in vaginal delivery of healthy infants and 2 (28.5%) had evacuation. Six (85.7%) patients received anticoagulants. Oral warfarin was used in all of these six cases throughout the first trimester. One (14.3%) of these patients ended in spontaneous abortion. One (14.3%) patient had blighted ovum and intravenous heparin was replaced for warfarin 24 hours before evacuation at 12 weeks of gestation. The remaining 4 (57%) patients continued warfarin through second trimester, and replaced by subcutaneous heparin at 34 weeks in 3(42.8%) patients and at 36 weeks in one (14.3%) patient. Coagulation monitoring, which was carried out in only 3 (42.8%) cases, revealed ineffective thromboprophylaxis. Ampicillin and gentamycin was given intravenously at start of labour and then 8 hourly for 48 hours ¡n 6 (85.7%) patients. Antenatal antibiotic prophylaxis was provided only to 1 (14.3%) patient by benzathaine penicillin (penidure-LA, Wythe) 1.2 x 106 units per month. Diuretics, digoxin and beta blockers were prescribed according to individual requirements of patients. Two patients developed pulmonary oedema treated effectively in the intensive care unit l.C.U. There was no mortality in this study. A concerted effort by all the concerned specialties in patients management is necessary to ensure safe outcome. The role of subcutaneous instead of intravenous heparin for prophylaxis in pregnancy should be evaluated by further studies.