目的 探讨心脏瓣膜置换术后妇女妊娠期抗凝治疗及分娩期的处理方案.方法 回顾性分析2004年7月至2010年7月收治的30例心脏瓣膜置换术后孕妇,观察妊娠期、分娩前后抗凝药物应用、分娩方式及妊娠结局.结果 2例心脏瓣膜置换时间超过10年的孕妇于中期妊娠因机械表功能障碍,瓣口血栓急诊再次行瓣膜置换术,1例孕期停抗凝药物孕晚期出现瓣膜血栓、心功能衰竭.孕妇合并妊娠期糖耐量异常2例,妊娠期高血压1例.中孕引产3例(10.00%),阴道分娩2例(6.67%),剖宫产25例(83.33%),无产后出血发生.围产儿结局:脑积水2例(6.67%),胎死宫内2例(6.67%).新生儿出生体重1.95~4.20kg,平均2.90±0.43kg.低出生体重儿3例(10.00%),巨大儿1例(占3.33%),新生儿轻度窒息3例(10.00%),无新生儿缺血缺氧性脑病,无新生儿颅内出血.结论 心脏瓣膜置换时间、妊娠期抗凝治疗影响妊娠结局,心脏瓣膜置换术妇女最好在术后2~3年妊娠,口服小剂量华法林简便易行,患者依从性好,胎儿畸形率低,并可有效地预防孕产妇瓣膜血栓栓塞的发生;分娩期以剖宫产为首选方式,术前及时停用抗凝药物、术后24小时恢复用药对产妇及新生儿是一种安全的处理方案.%Objetive To investigate the anti-coagulative therapy in gestational period after cardiac valve replacement and the delivery treatments. Methods 30 cases of pregnancy after cardiac valve replacement were treated from July 2004 to July 2010, a retrospective analysis was carried out concerning the application of anti-coagulative agents in gestational period and delivery, patterns of delivery and pregnancy outcomes. Results Two cases, who underwent cardiac valve replacement more than 10 years ago, accepted a second emergent valve replacement in midtrimester due to the mechanical dysfunction and prostheses thrombosis. Prostheses thrombosis and heart failure occurred late during pregnancy in 1 case who quitted anti-coagulative agents. There were 2 cases with gestational diabetes mellitus and 1 with hypertensive disorder complicating pregnancy. Induced labor was executed in mid-term in 3 cases ( 10. 00% ). There was vaginal delivery in 2 cases ( 6. 67% ) and C-sect in 25 cases ( 83. 33% ) without postpartum hemorrhage. Concerning the perinatal results there were 2 cases ( 6. 67% ) of hydrocephalus and 2 cases ( 6. 67% ) of fetal death. The range of birth weight was 1. 95 ~ 4. 2kg, and the average weight was 2. 90 ±0.43kg. There was 3 cases with low birth weight ( 10. 00% ), 1 case with fatal macrosomia ( 3. 33% )and 3 cases with neonatal asphyxia ( 10. 00% ). No one suffered from hypoxic ischemia or intracranial haemorrhage. Conclusion Both the time of cardiac valve replacement and anti-coagulative therapy during pregnancy affect pregnancy outcomes, and the optimal time for pregnancy may be 2nd or 3rd year after surgery. Oral administration of Warfarin turns out to be simple and easy to be accepted with low rate of deformity, which can prevent the prostheses thrombosis in pregnant women effectively. C-sect delivery is the first option for delivery. Stopping using of anti-coagulative agents in time before surgery and restoring within 24 hours after surgery is a safe method for maternity and fetus.
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