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Pregnancy After Cardiac Surgery

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Abstract

Heart disease is one of the common, indirect obstetric causes of maternal death. Management of these cases may challenge the entire team providing care to the mother and fetus. Advances in cardiac surgery has improved quality of life and level of functioning of cardiovascular system of patients with congenital or acquired heart disease. These diseases complicate 0.1–4 % pregnancies. Maternal complications in the form of thromboembolic, hemorrhagic episode and heart failure may occur. The fetus is in danger of effects of oral anticoagulation therapy and other medications given to the patient in order to support cardiovascular system, intrauterine growth restriction and danger of hypoxia. In recent era, we are facing more pregnant patients with previous history of surgical correction of congenital or rheumatic heart disease. In this review, we have attempted to draw a management protocol of such patients based on the available literature and various international guidelines. In pregnant women with mechanical heart valves, recent data support warfarin use throughout pregnancy, followed by a switch to heparin and planned induction of labor. However, the complexity of this situation demands a cafeteria approach where the patient herself can choose from the available options that are supported by evidence-based information. Preconception counseling, evaluation and antenatal high-risk management protocol with the help of cardiologist and cardiac surgeon improves maternal and neonatal outcome.

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Abbreviations

AHA:

American Heart Association

ACCP:

American College of Chest Physicians

ESC:

European Society of Cardiology

INR:

International normalized ratio

LMWH:

Low molecular weight heparin

UFH:

Unfractionated heparin

OAC:

Oral anticoagulants

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Chirayu Medical College and Hospital, Bhopal-Indore Highway, Near Bairagarh, Bhopal, Bhopal, MP, 462030, India

    Anjali Vivek Kanhere

  2. Department of Cardiothoracic Surgery, Chirayu Cardiac Center, Chirayu Medical College and Hospital, Bhopal, Bhopal-Indore Highway, Near Bairagarh, Bhopal, MP, 462030, India

    Vivek Madhav Kanhere

Authors
  1. Anjali Vivek Kanhere
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  2. Vivek Madhav Kanhere
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Correspondence to Anjali Vivek Kanhere.

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The author has no conflict of interest.

Additional information

Anjali Vivek Kanhere, MBBS, MD, FICOG FAIMER Fellow (GSMC Mumbai 2011), is a Professor and Head of Department, Department of Obstetrics and Gynecology at Chirayu Medical College and Hospital, Bhopal. Vivek Madhav Kanhere, MBBS, MS, MCh (Cardiothoracic Surgery), is a Consultant and Assistant Professor in Department of Cardiothoracic Surgery at Chirayu Cardiac Center, Chirayu Medical College and Hospital, Bhopal.

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Kanhere, A.V., Kanhere, V.M. Pregnancy After Cardiac Surgery. J Obstet Gynecol India 66, 10–15 (2016). https://doi.org/10.1007/s13224-016-0841-y

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