Pregnancy and prosthetic heart valves: A case series

Objectives: To assess the problems faced by pregnant women with prosthetic cardiac valves in terms of maternal and neonatal outcomes. Settings: Tertiary-level teaching hospital. Population: All pregnant women with prosthetic cardiac valves visiting the hospital in the period between January 2008 and September 2012. Method: Retrospective observational case series study. Results: Among the women presenting for antenatal visits to the hospital in the study period, eight were found to be have prosthetic cardiac valves. All cases had rheumatic origin of their cardiac lesion. Five cases had a mitral valve replacement. One had aortic and two had double-valve replacement. All patients had mechanical valves and were on anticoagulant regimen. Among them, one patient developed valve thrombosis and another developed embolic transient ischemic attack while in labor. Two patients developed symptomatic arrhythmia requiring treatment, while one patient had pneumonia with parapneumonic effusion. Three cases had abortions, while the other five pregnancies delivered live babies. All deliveries took place by lower segment Caesarean section (LSCS) for indications other than the cardiac condition. One pregnancy was complicated by intrauterine growth restriction and oligohydramnios. No patient developed any complications during the LSCS. There were no cases of warfarin embryopathy observed. Conclusion: Maternal complications tend to be higher in pregnant women with prosthetic cardiac valves requiring strict adherence to anticoagulant regimens and specialized treatment in tertiary care centers.