scholarly journals Continued use of Warfarin in lower dose has safe maternal and neonatal outcomes in pregnant women with Prosthetic Heart Valves

2021 ◽  
Vol 37 (4) ◽  
Author(s):  
Shafaq Nadeem ◽  
Shahbaz Ahmad Khilji ◽  
Faisal Ali ◽  
Anjum Jalal
Keyword(s):  
Birth Weight ◽  
Pregnant Women ◽  
Valve Replacement ◽  
Prosthetic Valve ◽  
Heart Valves ◽  
Prosthetic Heart Valves ◽  
Fetal Outcomes ◽  
Maternal And Neonatal Outcomes ◽  
Continued Use ◽  
Pregnant Mothers

Background and Objective: There has been concerns regarding the safety of Warfarin in pregnant females due to its teratogenic potential. At the same time warfarin provides best anticoagulation in patients with prosthetic valves. Various dosage regimes have been tried to strike a balance between safety of mother and the avoidance of congenital anomalies in the newborn. This study was conducted to observe the effect of Warfarin in pregnant mothers taking different doses of warfarin, and their neonatal outcome, in our outdoor patients. Methods: This is a cross sectional observational study conducted at the Faisalabad Institute of Cardiology. The pregnant mothers taking warfarin for prosthetic valve replacement who presented to our specialized clinic between November 2016 to April 2017 were included in the study. These included a total of 75 females between the age of 20-35 years. To compare the dose related effect of warfarin, two groups of the patients were formed. One group comprised of patients taking warfarin ≤5mg while the other group consisted of those who were taking >5mg of warfarin daily. These patients were followed till their delivery. The information was collected about the maternal and fetal outcomes. The maternal outcomes including mode of delivery/miscarriage, peripartum bleeding and any valve related thromboembolic complications. The fetal outcomes included birth weight, maturity, embryopathy and congenital anomaly in the baby. Results: Patient’s mean age was 29.25±3.75 years. The mitral valve replacement was present in 60% patients (n=45) while 25.3% patients (n=19) had aortic valve replacement and 14.7% patients (n=11) had double valve replacement. In this group 30 patients (40%) had taken <5 mg warfarin and 45 patients (60%) had received >5 mg warfarin medicine. Miscarriages, cesarean sections, low birth weight and prematurity were more common in patients receiving warfarin >5 mg with p-values 0.005, 0.046, 0.01 and 0.033 respectively. No case of fetal embryopathy was found in both groups. Conclusion: No case of embryopathy was found in each group which signifies that warfarin in lower doses is safe anticoagulant in patients with prosthetic valve replacements. doi: https://doi.org/10.12669/pjms.37.4.3924 How to cite this:Nadeem S, Khilji SA, Ali F, Jalal A. Continued use of Warfarin in lower dose has safe maternal and neonatal outcomes in pregnant women with Prosthetic Heart Valves. Pak J Med Sci. 2021;37(4):---------. doi: https://doi.org/10.12669/pjms.37.4.3924 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Comparison between two different regimens of anticoagulants for pregnant women with prosthetic heart valves

2017 ◽  
Vol 6 (6) ◽  
pp. 2158
Author(s):  
Mustafa Bahloul ◽  
Armia Michael ◽  
Mansour Y. Kandeel ◽  
Ahmed M. Abbas
Keyword(s):  
Pregnant Women ◽  
Heart Valves ◽  
Oral Anticoagulants ◽  
Prosthetic Heart Valves ◽  
Fetal Outcomes ◽  
Warfarin Group ◽  
Group I ◽  
Significant Difference ◽  
Sequential Regimen ◽  
Group Ii

Background: The current study aims to assess the maternal and fetal outcomes of pregnant females with prosthetic heart valves receiving oral anticoagulants only versus the sequential regimen of heparin and OA throughout pregnancy.Methods: An observational was carried out at Assiut Women's Health Hospital, Egypt between February and December 2016. All pregnant women with prosthetic heart valves attending the emergency department during the study period were enrolled in the study. All included patients were classified into two groups; women who receive low molecular weight heparin (LMWH) during the first trimester then shift to warfarin till 36 weeks of gestation then continue on LMWH till delivery (Group I) and those who continue the all period of pregnancy on warfarin (Group II). The primary outcome of the study was the difference in the rate of maternal cardiac complications during labor between both groups.Results: The study included 72 patients have prosthetic valve replacement and on anticoagulants. Twenty-one were on oral anticoagulant; warfarin (Group II) and 51 pregnant women were on sequential regimen. Both groups were comparable in their basic and clinical data on admission. No difference between both groups in the mode of delivery (p=0.52), postpartum hemorrhage (0.09), sub rectal hematomas (p=0.08), the need for postpartum admission to ICU (p=0.93) and the duration of hospital stay (p=0.47). Additionally, no statistical significant difference between both groups as regard the mean birth weight (p=0.97), Apgar score (p=0.62), fetal sex (p=0.92) and congenital anomalies (p=0.08).Conclusions: The use of sequential LMWH and oral anticoagulants appears to be a safe option for those women although there is no difference in maternal and fetal outcomes with the use of continuous oral anticoagulants throughout the pregnancy.

Advanced Maternal Age and Adverse Maternal and Neonatal Outcomes in Pregnant Women

2020 ◽  
Vol 16 ◽  
Author(s):  
Reza Omani-Samani ◽  
Saman Maroufizadeh ◽  
Nafise Saedi ◽  
Nasim Shokouhi ◽  
Arezoo Esmailzadeh ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Low Birth Weight ◽  
Cesarean Section ◽  
Pregnant Women ◽  
Maternal Age ◽  
Unwanted Pregnancy ◽  
Advanced Maternal Age ◽  
Neonatal Outcomes ◽  
Maternal And Neonatal Outcomes

Background: Advanced maternal age is an important predictor for maternal and neonatal outcomes such as maternal mortality, low birth weight, stillbirth, preterm birth, cesarean section and preeclampsia. Objective: To determine the association of advanced maternal age and adverse maternal and neonatal outcomes in Iranian pregnant women. Methods: In this hospital-based cross-sectional study, 5117 pregnant women from 103 hospitals in Tehran, Iran, were participated in the study in 2015. The required data were gathered from hospitals which equipped to the department of obstetrics and gynecology. Advanced maternal age was considered as an independent variable and unwanted pregnancy, preeclampsia, preterm birth, cesarean section and low birth weight were considered as interested outcomes. Results: In our study, the prevalence of advanced maternal age was 12.08%. Advanced maternal age was significantly associated with higher risk of unwanted pregnancy (OR: 1.39, 95% CI: 1.12-1.73), preterm birth (OR: 1.75, 95% CI: 1.28- 2.39) and cesarean section (OR: 1.34, 95% CI: 1.03-1.74). In our study, there was no significant relationship between advanced maternal age and preeclampsia but this relationship could be clinically important (OR: 1.48, 95% CI: 0.99-2.20, P=0.052), and there is no significant relationship between advanced maternal age and low birth weight (OR: 1.08, 95% CI: 0.67-1.74, P=0.736). Conclusion: Advanced maternal age is associated with higher risk of unintended pregnancy, preterm birth and cesarean section but our findings did not support advanced maternal age as a risk factor associated with low birth weight.

Technique of surgical aortic valve implantation using single interrupted annular sutures

2020 ◽  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Heart Valves ◽  
Intraoperative Complications ◽  
Coronary Artery Occlusion ◽  
Artery Occlusion ◽  
Prosthetic Heart Valves ◽  
Surgical Aortic Valve Replacement ◽  
Conduction Disturbances

The introduction of the first surgical prosthetic heart valves in the early 1960s made effective treatment of aortic valve disease possible. The goal of surgical aortic valve replacement is to replace the diseased aortic valve with a properly functioning, sufficiently large prosthesis while avoiding intraoperative complications such as conduction disturbances, coronary artery occlusion, or paravalvular leaks. Although most commonly, non-everting pledgeted mattress sutures are used to implant the prosthesis during surgical aortic valve replacement , interrupted single sutures without pledgets can be a useful alternative, especially in patients with a small tissue annulus, because they theoretically maximize the orifice available for flow. This tutorial discusses the surgical technique of surgical aortic valve replacement using interrupted single annular sutures.

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