Hypertrophic Cardiomyopathy and Pregnancy

Clear and present danger: Mechanical heart valves in pregnancy

“…9 This recommendation is based on evidence for the high rate of MHV thrombosis in the antenatal period, data showing reduced risk of MHV thrombosis outside pregnancy by the addition of aspirin 10 and the ROPAC data finding no women taking aspirin had an MHV thrombosis. 3 A dose of 75 mg daily is advised, increasing to 150 mg if there are risks of preeclampsia, and stopping at 3 days before a planned delivery to reduce the risk of postpartum haemorrhage (PPH).…”

“…Focus of attention is often on peri-delivery management 1 but most adverse thrombotic events occur antenatally 2 with approximately half occurring in the first trimester. 3 In this issue, Dr Lester and colleagues, on behalf of the British Society for Haematology, tackle this difficult subject, providing best practice guidance, drawn from available evidence of MHV management outside of pregnancy, observational data in pregnancy and experience and opinion of multidisciplinary experts in the field; coauthors are from haematology, cardiology, anaesthetics, obstetrics and obstetric medicine, with input from specialists in neonatology, cardiac surgery, midwifery and biomedical science. Each speciality has its own roles and responsibilities in the care of these women, as defined at the end of the guideline.…”

“…5 Equally, the likelihood of bleeding is also very high, with the large international European Society of Cardiology Registry of Pregnancy and Cardiac Disease (ROPAC), reporting haemorrhagic complications in 23%. 3 If data from these two registries are accurate, outcomes in the UK are worse than those seen in other European countries, with only 28% having good maternal outcomes, compared to 58% identified by ROPAC. It is possible that ROPAC is more subject to reporter bias and omission of early complications, compared to UKOSS which prospectively gathered data on all pregnant women with MHV during the given time period.…”