الفهرس 
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Abstract
Pregnancy after mechanical heart valve replacement is highly risky for both mother and child because of the aggravation of maternal heart function and adverse effects of anticoagulation therapy. It has the potential risks of maternal heart failure, arrhythmia, infectious endocarditis, and maternal death with advancing gestational age [154].
Therapeutic anticoagulation is recommended in all pregnant women with mechanical prosthetic heart valves to prevent the life threatening complications, valve thrombosis and thromboembolic events [7, 8].
This was a prospective observational study which enrolled 50 pregnant women who had had implanted mechanical cardiac valve prosthesis and presented to Beni-Suef University Hospital over one year period starting from 1/6/2015 till 31/6/2016.
In our study, the mean age of pregnant women was 26.18 ± 5.44 years and the most common replaced valve was mitral valve.
9 patients developed cardiac complications during pregnancy.4 patients presented with atrial fibrillation, prosthetic valve thrombosis in 5 patients. One patient was re-operated 20 days after delivery, 3 patients received thrombolytic therapy, and 1 patient died. 4 patients were complicated by bleeding. The postpartum haemorrhage was the most common cause which usually life threating and need blood transfusion. [Figure 24]
Figure 24: Maternal complications
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Abstract Summary
35 pregnancies ended up in healthy live birth babies, 10 pregnancies ended up in abortion, 3 pregnancies ended up in intra uterine fetal death and perinatal deaths occurred in 2 patients. There were 3 babies with congenital anomaly, ventricular septal defect, cleft soft palate tongue, diaphragmatic hernia and hydrocephalus. Warfarin embryopathy was not detected in any patient. [Figure 25].
Figure 25: Fetal Outcomes
Women who received more than 5 mg warfarin daily were more liable for hemorrhagic complications and had more fetal loss. Warfarin in 1st trimester was safer to the mother but associated with more fetal loss especially if the dosage is more than 5 mg daily.
Maternal complications were more frequent in women who received Clexane or Unfractionated Heparin during 1st trimester especially prosthetic valve thrombosis but fetal outcome was better as heparin does not cross the placenta.
It is better to pregnant women with prosthetic heart valves to be closely followed by cardiologist and obstetrician during pregnancy.