الفهرس 
Effect of repeated pregnancy on pregnancy outcomes in women with mechanical prosthetic cardiac valves
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Abstract
Background: Pre-pregnancy counselling in patients with mechanical prosthetic heart valves may improve compliance to anticoagulation regimen and reduce rate of complications. With repeated pregnancies, patients’ health awareness build up and this may further reduce the rate of maternal and fetal complications. Purpose: To evaluate effects of repeated pregnancy, after maternal mechanical prosthetic cardiac valve implantation, on improving maternal and fetal outcome. Methods: This study prospectively enrolled 128 pregnant ladies, with mechanical prosthetic heart valves, who presented to high risk pregnancy outpatient clinic. Full surgical history was taken including date of surgery, type and location of valves replaced, any previous bleeding or thrombotic complications and average dose of warfarin controlling INR level. Cardiac and obstetric follow up visits were scheduled every month for the first seven months of pregnancy, then bimonthly in the eighth month and then weekly till delivery. Anticoagulation regimen was recommended according to the latest guidelines. Results: Most of the patients presented in the first trimester (84.4%) and their mean age was 29.1±5.3 years. About two thirds (60.9%) of the patients had mitral valve prosthesis, 18.8% had aortic valve prosthesis and 20.3% had double valve prostheses. Sixty eight percent of the ladies fulfilled >80% of the planned follow up visits and of those, no fetal losses were recorded. Patients were divided into two groups: group 1 whose current pregnancy was the first after valve replacement (33.6%) and group 2 whose current pregnancy was a multiple after valve replacement (66.4%). Both groups showed no difference in the rate of maternal bleeding (p=0.3) or thrombotic complications (p=0.6) or the rate of fetal abnormalities (p=0.2) but the rate of compliance to follow up visits was significantly higher in group 2 patients (p=0.015). The mean warfarin dose used to control the INR to its therapeutic level was 6.4±2.4 mg/day pre-pregnancy and 5.8±1.5 mg/day during current pregnancy (p=0.08). No maternal losses were recorded