Postpartum hemorrhage in the setting of a mechanical heart valve
Author:
Perdigao Joana Lopes,McQueen Dana,Nunes Kenneth,DiGiovanni Laura
Abstract
Abstract
Background:
Therapeutic anticoagulation is required for all patients with prosthetic mitral valves. Anticoagulation with warfarin is recommended; however, warfarin is teratogenic in early pregnancy and therefore alternate anticoagulation regimens are suggested for pregnant patients.
Case:
A 28-year-old gravida 2, para 1 woman at 36 weeks’ gestation with a prosthetic mitral valve and a history of a corrected anomalous origin of the left coronary artery arising from the left pulmonary artery presented in labor. She underwent a spontaneous vaginal delivery complicated by a postpartum hemorrhage necessitating a hysterectomy.
Conclusion:
Management of mechanical valves in pregnancy is controversial. The provider must weigh the risks of life threatening valve thrombosis and malfunction against the risk of significant hemorrhage. This case report reviews peripartum anticoagulation protocols and management of massive hemorrhage in patients with prosthetic mechanical valves.
Publisher
Walter de Gruyter GmbH
Subject
Obstetrics and Gynecology,Embryology,Pediatrics, Perinatology and Child Health
Reference34 articles.
1. AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines;J Am Coll Cardiol.,2014
2. Pregnancy complicated by valvular heart disease: an update;J Am Heart Assoc.,2014
3. Pregnancy outcomes and cardiac complications in women with mechanical, bioprosthetic and graft valves;Br J Obstet Gynaecol.,2000