Risiken und Erfolgsaussichten einer Schwangerschaft nach Herzklappenersatz

Abstract

After replacement of a heart valve a pregnancy is possible in the complaint categories I and II. Treatment with anti-coagulation is necessary for plastic heart valves. To avoid teratogenic effects the early pregnancy is best managed with heparin although stillbirth and early intra-uterine death are more common than with Marcumar. A treatment with heparin 10,000 units subcutaneously twice throughout all of the pregnancy is recommended. According to the literature 2/3 of the pregnancy with anti-coagulation result in the normal delivery of a healthy infant. Of 202 women in the reproductive age group with artificial heart valves, 150 were followed by a questionnaire. 25 women desired children. 10 women had pregnancies. 1 had two pregnancies, 1 had three pregnancies, 3 healthy infants were born.

Prosthetic Heart Valve and Pregnancy

“…In the review by Rein ct al. [3] until 1978, there were 2 maternal deaths in 118 pregnancies, both during puerperium and due to valve thrombosis. BenIsmail et al [9] published another case of puerperal maternal death, of thromboem bolic etiology, in 16 pregnancies.…”

“…As a rule, in a cardiac patient there are three moments generally considered to be a major risk during pregnancy [3]: between weeks 24 and 36, during delivery and around the 4th day of postpartum. In our patients, as well as in most of the series that we reviewed, there was no complication during delivery, probably because of an improved hemody namic situation (compared to the nonoperated cardiac patients) and of the tendency to shorten the delivery.…”

“…[3], pregnancy can be advised in cases of bioprosthesis, stage I and II of NYHA and sinus rhythm, while in cases with metal prosthesis, anticoagulation and auricular fibrillation it has risks. In our study auricular fibrillation did not have a poorer prognosis.…”

“…Kochsiek and Eichstädt [16] and Rein et al [3] established as absolute contraindica tions to pregnancy stages III and IV of NYHA and pulmonary hypertension. Ac cording to our results we would add to those, for the metal prosthesis: maternal age over 30 years, lapse of time since valve replacement of more than 5 years and especially of more than 7 years, and a history of postoperative decompensation or thromboembolism.…”

“…Reviewing the world lit erature until 1978, Rein et al [3] found a total of 118 reported pregnancies in 100 women. The largest known series arc from Repolles [4] (30 pregnancies in 26 women) and from Lutzet al [5] (40 pregnancies in 23 women).…”