机械瓣膜置换术后华法林对妊娠与分娩过程的影响

Outcome of Women with Cardiac Valve Replacement Applying Warfarin during Their Pregnancy

目的：探讨心脏瓣膜置换术后产妇适合的抗凝方案以及华法林对妊娠和分娩过程的影响。方法：回顾性分析该院1998年1月～2004年12月的23例机械瓣膜置换术后妊娠、分娩的病例资料。21例于12周前换用肝素，有2例始终服用华法林，其中17例足月分娩，均37周左右住院，术前3d华法林改用肝素钠，监测APT值，术后24h恢复华法林。结果：6例为早中期流产或死胎而中止，其中3例为3个月前流产。17例分娩均行剖宫产，新生儿体重2600～3500g，有4例出现不同形式的胎儿畸形，2例一直服用华法林未换肝素钠者，其胎儿为正常儿。所有孕妇分娩后心功能均维持在Ⅰ～Ⅱ级，术中出血量为（247±139）ml，无严重出血及栓塞等并发症而导致的死亡病例。结论：妊娠期间口服华法林能有效防止血栓形成，且不会增加分娩时母婴出血，但可能对胎儿畸形和流产有一定的影响。

Objective： To determine the outcome of pregnant women with cardiac valve replacement applying warfarin during their pregnancy. Methods： There were 23 cases of pregnant women with cardiac valve replacement during 1998/1 to 2004/12. Twenty - one cases changed warfarin to heparin in the earlier 12 weeks, and 2 cases kept using warfarin. Seventeen cases of term delivery were received at 37 weeks and changed warfarin to heparin 3 days before operation. The value of APPT was monitored and warfarin was reused 24 hours after operation. Results： The 17 cases of term delivery received Caesarean section and the weight of newborn was 2 600 g to 3 500 g. There were 4 cases of teratism, but the 2 cases keeping using warfarin was normal. The cardiac function maintained stable after delivery, the bleeding during operation was （247±139） ml, and no severe complications and death occurred. Conclusion： Application of warfarin during pregnancy can avoid thrombosis and do not increase bleeding in delivery , but maybe results in teratism or abortion.