A Study of Fertility and Pregnancy Outcomes in Women after Surgery for Valvular Heart Disease

A. Malempati, S. Palanki, N. Dixit
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Abstract

Chronic Rheumatic Heart Disease (CRHD)is a common condition in India. CRHD accounts for a majority of heart valve surgery, including those in the younger age group. These young women almost traditionally get married in a country like India, and the social pressure to bear children is tremendous. Anticoagulation and the postoperative state of the patient itself can be a risk factor for maternal and fetal outcomes. There is very little data available for the same in India. In this study, 100 cases were studied retrospectively to study the fertility patterns after valvular heart surgery including fetal outcomes. This study was conducted at Nizam’s Institute of Medical Sciences, Hyderabad in which pregnancy, anticoagulation, maternal and fetal outcomes were studied. A total of 63 patients conceived after surgery (pregnancy rate = 63%/ failure rate =37%) (p=0.001). Fetal loss occurred in 6 of the pregnancies, due to spontaneous abortion (n=3) and medical abortion (n=3). Parity, associated conditions and age did not affect the outcome. During pregnancy, 28 patients switched to UF heparin, 31 stayed on warfarin, 4 did not take any anticoagulation. Fetal loss was observed in 3 patients on Warfarin during pregnancy and 3 on UF heparin. Maternal loss was observed in 4 patients out of which 2 were on Warfarin, 1 on unfractionated UF heparin and 1 did not take any anticoagulation during pregnancy. In comparison, warfarin and UF heparin had similar fetal outcomes. The study recorded good outcomes irrespective of type of prosthesis and anticoagulation.
瓣膜性心脏病术后妇女生育能力和妊娠结局的研究
慢性风湿性心脏病(CRHD)是印度的一种常见疾病。CRHD占心脏瓣膜手术的大多数,包括年轻年龄组的手术。在印度这样的国家,这些年轻女性几乎是传统上结婚的,生育孩子的社会压力是巨大的。抗凝和术后患者本身的状态可能是产妇和胎儿结局的危险因素。在印度,这方面的数据很少。在本研究中,我们回顾性研究了100例心脏瓣膜手术后的生育模式,包括胎儿结局。这项研究是在海得拉巴的尼扎姆医学科学研究所进行的,研究了妊娠、抗凝血、母婴结局。术后妊娠63例(妊娠率63%/失败率37%)(p=0.001)。由于自然流产(n=3)和药物流产(n=3), 6例妊娠发生胎儿丢失。胎次、相关条件和年龄对结果没有影响。在怀孕期间,28例患者改用UF肝素,31例继续使用华法林,4例未使用任何抗凝剂。妊娠期使用华法林3例,使用UF肝素3例。妊娠期产妇丢失4例,其中2例使用华法林,1例使用未分离UF肝素,1例未使用任何抗凝药物。相比之下,华法林和UF肝素有相似的胎儿结局。该研究记录了良好的结果,无论假体和抗凝类型如何。
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