a1 Medical Disorders of Pregnancy Program, Division of Maternal Fetal Medicine, Mount Sinai Hospital, University of Toronto, Canada.
Mechanical heart valves pose a particular challenge in pregnancy, as the primary agent used to prevent valve thrombosis, coumadin (warfarin), is a known teratogen. Alternatives to coumadin, such as unfractionated heparin (UFH) and low-molecular weight heparin (LMWH) are safer for the fetus, particularly during the first trimester of pregnancy, but expose the mother to potential valve failure. This review will examine these controversies and the complex literature regarding management in pregnancy.
c1 Cynthia Maxwell, Mount Sinai Hospital, Department of Obstetrics and Gynaecology, 600 University Avenue, Toronto ON, M5G 1X5 Canada.