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

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.