PREGNANCY AND ANTICOAGULATION IN RHEUMATIC HEART DISEASE - MATERNAL AND PERINATAL OUTCOME
Dr. Rachita Garg*, Dr. Dinky Arora, Dr. Preeti Singh, Dr. Latika Sahu, Dr. Nasrin Fatima and Dr. Amrit Adarsh
ABSTRACT
Introduction: Heart disease complicates 1-3% pregnancies, with RHD comprising 69% of all cardiac disorders seen in pregnancy in India. Mechanical heart valves (MHVs) increase the risk of thromboembolism, and systemic anticoagulation is required to prevent adverse outcomes including valve thrombosis, stroke, and death. Objective: To study maternal and perinatal outcomes in RHD patients on various regimes of anticoagulants during pregnancy. Methods: All pregnant women with Rheumatic heart disease (RHD) requiring anticoagulation were included. Complete evaluation was done with obstetric history, past history, surgical intervention, treatment history, obstetrical and cardiovascular examination and relevant investigations including echocardiography was done. Maternal and perinatal outcomes were observed and analysed. Results: Over a study period of one year, 150 RHD patients were recruited and 10% of them (n=15) required anticoagulation. Patients were divided into four groups based on the anticoagulant taken and need for switchover from oral anticoagulant to parenteral (LMWH) anticoagulant. It was observed that oral anticoagulants were safer for the mother in preventing cardiac complications while LMWH was safer for the fetus. Conclusion: Cardiac diseases are frequently encountered in pregnant females and knowledge about the different anticoagulant regime and their respective safety profile is essential to prevent adverse maternal and perinatal outcomes.
Keywords: RHD, Anticoagulation, LMWH.
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