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Re: Coumadin and pregnancyFrom: DoctorJoe@aol.comFri Jan 14 10:33:05 2000
In a message dated 1/14/00 11:24:08 AM, md2b99@yahoo.com writes: << I need some advice from other medical professionals on a subject. My step daughter is 21 and had a congenital defect in her heart repaired 3 years ago. She now needs a replacement of her mitral valve with a mechanical one. She is conserned about not being able to have children and has found several internet articles and chat areas that talk about women having successful pregnancies while on coumadin. Therefore, I have three questions I would like to pose. 1. Is there an absolute contraindication to pregnancies and coumadin therapy? 2. What are the possible consequences of a pregnancy with a mitral valve replacement. 3. Could she use sq hepain/lovenox while pregnant? >> Standard recommendations: 1. Coumadin is relatively contraindicated in the 1st trimester due to congenital anomalies, and near term, due to possible fetal hemorrhage. 2. With a mitral valve replacement coexistent with pregnancy, there should be little cardiac problem if the heart is otherwise normal. If there is residual insufficiency or stenosis, then that needs to be considered. On the other hand, in someone with a congenital heart defect, HER BABY has about a 3% chance of cardiac anomalies, the same as any polygenic defect. 3. Heparin can be used in pregnancy. The "standard" strategy for handling pregnant women in need of anticoagulation is to use heparin in early pregnancy, say until about 12-14 weeks, and then switch back to coumadin until a few weeks before delivery. Then switch to heparin peripartally, then back to coumadin postpartally. Of course, there are lots of variations as to how to do this. Joe P.
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