This study was undertaken to evaluate the risks and preg-nancy outcome in women with prosthetic heart valves on different anticoagulent regimens.A retrospective chart re-view of 82pregnancies in 33women wit h mechanical valve prostheses at a tertiary referral ce nter from 1987to 2002.The main outcome measures were majormaternal complica-tions and perinatal outcome.The valve replaced was mitral(60.6%),aortic(18.2%),and both(21.2%).Fifty -four pregnancies(65.9%)resulted in live births,9(11.0%)had stillbirths(all on warfarin),and 12(14.6%)had spontaneous and 7(8.5%)therapeutic abortions(all on warfarin).The rate of spontaneous abor-tion was highest in women on warfarin throughout preg-nancy(P<.01).The live birth rate was higher in wom en on heparin compared with those on warfarin(P<.01),and in those on heparin /warfarin com pared with warfarin alone(P<.01).There were no maternal deaths;howe v-er,3patients had mitral valve throm bosis(2on heparin and 1on warfarin)necessitating surgery in 1patient a nd medical thrombolysis in 2patients.Hemorrhagic compli-cations occurred in 5patients,4of whom required trans-fusion.No single anticoagulant regimen confers completeprotection from thromboembolic phenomena in pregnancy.Despite a high maternal morbidity ra te,the perinatal out-come is acceptable when pregnancy pr ogresses beyond the first trimester.
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