报告_机械瓣膜置换术后孕产妇处理.pptVIP

Management of Pregnant Woman with Mechanical Heart Valves -- A Case Based Discussion Department of Anesthesiology the First Affiliated Hospital of Soochow University Key words G3P2 孕3产2 gravida I或primigravida gravida II或secundigravida gravida III或tertigravida para O 未产妇 para Ⅰ初产妇 para Ⅱ、Ⅲ、Ⅳ Peripartum 围产期 Gestation 怀孕, 酝酿, 妊娠 Thrombosis 血栓形成 Thromboembolism 血栓栓塞 Embryopathy 胚胎病 Osteoporosis 骨质疏松症 Teratogenic 畸形形成的hypoplasia 发育不全 Case Introduction 25 years, G3P2 gestation 6 weeks, 2 children, S.V.Delivery. 1st pregnancy: Dyspnoea(30 weeks), Mitral Regurgitation, Diuretic-Rest-Observation, MVR, Anticoagulation(warfarin). 2nd pregnancy: 2 years later, uneventful, S.V.Delivery. Risk of Prosthetic Valve Thrombosis Tissue valve: wearing out and necessitating replacement. Mechanical valve: longevity but life-long anticoagulation. prosthetic valve thrombosis(PVT): 0.7~6.0% per patient per year(1.3%-obstruction) VS 25% with no anticoagulation. Thromboembolism in pregnant women with prosthetic heart valve: 7~23% per pt per year. Factors increasing the risk of PVT Mechanical Valve Tissue Valve Right Heart Left Heart Mitral Valve Aortic Valve Hypercoagulable state of pregnancy Interruption to Anticoagulation Considerations during Anticoagulation Anticoagulation drugs: 1. Warfarin 2. Unfractionated heparin (UFH) 3. low molecular weight heparin (LMWH) Balance of two risks: 1. Valve thrombosis 2-1. Direct harm to fetus 2-2. Haemorrhage to both mother and fetus Warfarin Best protection in mother, best interest of unborn child. Crossing the placenta: fetal loss, embryopathy. Fetal and neonatal haemorrhage. Heparin Neither UFH nor LMWH cross the placenta, no direct harm to fetus, but less protection against PVT. LMWH UFH: thrombocytopenia and osteoporosis, subcutaneous absorption, long T1/2, dose-response effect. Valve thrombosis rate: 8.6%.- 81 pregnancy in 75 women with mechan