Maternal and Fetal Outcome in Pregnant Women with Mechanical Valve at The Royal Hospital: A Retrospective Study
Ahlam AL Hanashi*, Shamsa AL-Hinai and Alya AL-Madahani
Pregnancies in women with prosthetic heart valves have historically been associated with an increased incidence of adverse outcomes for both the mother and fetus. These outcomes include miscarriage, thromboembolism, postpartum hemorrhage (PPH), and prenatal complications such as preterm birth (PTB), small for gestational age (SGA), and congenital anomalies. The design of prosthetic heart valves has continued to improve, with highly thrombogenic ball valves and large-style valves being replaced by newer bioprosthetic types. These advancements have significantly reduced the need for anticoagulant regimens during pregnancy, leading to better outcomes. Consequently, alongside improvements in obstetric and medical care, the prognosis for pregnant women with mechanical heart valves has markedly improved. However, this patient group still faces unique challenges due to the necessity of anticoagulation therapy to prevent valve thrombosis while ensuring the safety of both mother and fetus. Introduction: Pregnancy in women with heart disease continues to be a clinical challenge due to the associated significant morbidity and pregnant women with mechanical heart valves has an increased risk of adverse outcome both maternal and fetal [1, 2]. However, the biomedical advancement in the heart valves raises the question if there is difference between the maternal and fetal outcome in the mechanical valves used: Prosthetic and Bioprosthetic heart valves. Therefore, we conducted a retrospective study to identify the maternal and fetal adverse outcome in women with mechanical heart valves and to compare the incidence of the adverse outcome between Prosthetic and Bioprosthetic heart valves pregnant women. Materials and Methods: A retrospective study was conducted in the Obstetrics and Gynecology Department at Royal Hospital, Oman. All pregnant women with mechanical heart valves who were followed and delivered at Royal Hospital over the past 10 years (January 2010 to December 2020) were included. The collected data included maternal, pregnancy, and fetal details based on the literature review. Data was collected from the Alshifa Electronic Medical Record System, and statistical analysis was performed using SPSS software. Fisher Exact test was used for measuring the statistically significant relationship between Prosthetic, Bioprosthetic and the outcome. Result: A total of 301 patients were included. 61 patients (20.3%) were Primi-gravida whereas (79.7 %) were women with multiple pregnancy. Bioprosthetic valve found in 199 patient (66.1%) of the included patients. (82.4%) 248 patient were with single valve replacement. The most common of replacement valve replacement Rheumatic heart disease by (59.5%). Since majority of the patient were with Bioprosthetic valve, (65.8%) were not on anticoagulation therapy. Regarding maternal outcome: Mortality rate was (2%), whereas other complication including valve thrombosis, PIH were (3%), Miscarriage was found in 21.3% of the cases and was seen more with patient who were on warfarin. The rate of cesarean section was (23%) comparing to spontaneous vaginal delivery (77%). Termination was indicated on 5 patient (1.7%) with variable reasons for terminations including maternal and fetal indications. For the Fetal outcome: 193 (64.1%) term, 15 (5%) preterm, out of which 43 (14.3%) required NICU admission. Perinatal mortality was (1.3%). 53 (17.6%) were Low Birth weight newborn. And 3 cases (1%) with fetal anomalies. Conclusions: Women with heart valve experienced highly risk of adverse outcome then expected in general obstetric population. Women with Bioprosthetic have less adverse outcome. Balancing the risks of thrombosis and bleeding complications during pregnancy is critical for optimal maternal and fetal outcomes. Multidisciplinary pre-pregnancy counselling is important.
