Maternal Health Outcomes in Nepalese Women After Mitral Valve Replacement

Abstract

Background: The effects of anticoagulation on maternal health in patients with prosthetic valves remain understudied. Our study aims to assess maternal health post-mitral valve replacement (MVR), pregnancy-related complications, maternal mortality, coagulation issues, and fetal and neonatal outcomes post-MVR.
Methods: This exploratory retrospective study, conducted from 2017-2020, included female patients of reproductive age who underwent MVR. Eligible participants were identified from hospital records, and pregnancy-related maternal outcomes were ascertained through review of medical records and a single cross-sectional telephone follow-up conducted between June and August 2023. Data on childbirth, abortion, anticoagulation management, and related complications were collected. Descriptive statistics were used for analysis.
Results: Of 474 female patients of childbearing age who underwent MVR, 380 responded to our survey. Of these, 18 cases (4.73%) involved pregnancy post-MVR. All pregnant patients were on anticoagulant therapy during pregnancy, with no maternal deaths reported. However, one patient experienced heart failure post-delivery. Bleeding was the most common complication, occurring in 5/18 pregnancies (27.7%). Seven pregnancies resulted in live births (38.8%), with one low birth weight infant. There were no congenital anomalies, but there was one intrauterine fetal death at 7 months and 2 spontaneous abortions. Seven pregnancies were electively terminated, though the reasons were not studied. One pregnancy was ongoing at the time of the study. All but one delivery occurred under medical supervision, with most patients following a warfarin-to-heparin regimen.
Conclusions: In this cohort, 4.73% of women experienced pregnancies post-MVR, with anticoagulation posing significant challenges. The low rate of maternal and fetal complications suggests a need for further research, particularly regarding the high rate of elective terminations.
Keywords: Maternal health; Nepalese women; outcomes.