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Flashcards in Obstetric cardiology Deck (8)
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1

What is the mortality rate of a foetus whose mother undergoes cardiopulmonary bypass?

15-30%

2

What are the harms of warfarin to a foetus?

Dose dependent increase in risk
Foetal anomalies 5-10%
Miscarriage 30%
Late foetal loss 10%

3

What are the benefits of warfarin to a pregnant female with mechanical valve compared to other anticoagulation?

10% absolute risk reduction of major adverse events (valve failure, thromboembolism and death) compared to Enoxaparin. (15% vs 5%)

4

What is the antithrombotic management of a pregnant female with an established bioprosthetic valve?

Aspirin through pregnancy

5

In the setting of a pregnant female with a mechanical valve, when would you consider adding aspirin?

When on heparin or LMWH

6

What are the risk factors for valve complications in a pregnant female with a mechanical valve?

Old or small mechanical mitral valve
Atrial fibrillation or flutter
Previous thromboembolism
Multiple mechanical valves

7

What is the anticoagulant strategy for pregnant females with mechanical valves at the end of term? (On warfarin or on LMWH)

If on LMWH

1. Hold enoxaparin 24 hours prior to induction/caesarean
2. Transition to heparin infusion (Without bolus) or prophylactic clexane
3. Aim to cease heparin 4-6 hours before delivery
4. Cease aspirin 7 days prior
5. Initiate anticoagulation 4-6 hours post or as soon as is safe from bleeding POV (heparin without bolus or enoxaparin prophylactic does 6 hours after and 0.75mg/kg BD at 12 hours post)

If on warfarin

1. Transition to enoxaparin at week 36 and as above
2. Consider adding aspirin

8

What is the target Factor xa level for BD clexane for a pregnant female with mechanical valves?

Aortic 0.8-1.0
Mitral 1.0-1.2

4-6 hours post dose