{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T03:33:00Z","timestamp":1788492780080,"version":"build-2803163510"},"reference-count":33,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,9,28]],"date-time":"2024-09-28T00:00:00Z","timestamp":1727481600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2024,9,28]],"date-time":"2024-09-28T00:00:00Z","timestamp":1727481600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The aim of the present study was to review maternal and fetal outcomes in pregnant women with prosthetic heart valves.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective record review of pregnant women with prosthetic heart valves on anticoagulation was performed at the Specialist Cardiac Antenatal Clinic, Johannesburg South Africa from 2015 to 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifty pregnancies with mechanical heart valves and three with tissue valves, on anticoagulation for comorbid atrial fibrillation were identified. The majority were of African ethnicity at a mean age of 33\u2009\u00b1\u20096\u2009years. Anti\u2010Xa adjusted enoxaparin was commenced at 10.5\u2009\u00b1\u20095.6\u2009weeks' gestation until delivery in 48 (90.6%) pregnancies and warfarin was continued in five (9.4%) pregnancies. The live birth rates on enoxaparin and warfarin were 56.3% (95% confidence interval [CI]: 42.3\u201369.3) and 20.0% (95% CI: 2.0\u201364.0), respectively. There were 12 (22.6%) miscarriages at a mean of 11.3\u2009\u00b1\u20093.7\u2009weeks' gestation, four (7.5%) intrauterine fetal deaths on warfarin and two (3.8%) warfarin embryopathy\/fetopathy. The rates of antepartum\/secondary postpartum bleeding and primary postpartum bleeding were 29.4% (95% CI: 18.6\u201343.1) and 5.9% (95% CI: 1.4\u201316.9), respectively. Maternal complications included anemia (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200911, 20.8%), arrhythmia (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092, 3.8%), heart failure (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092, 3.8%) and paravalvular leak (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092, 3.8%). There was one (1.9%) mitral valve thrombosis and one (1.9%) stuck valve in pregnancies who defaulted warfarin prior to pregnancy. There were no maternal deaths.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Multidisciplinary management of pregnant women with prosthetic heart valves with anti\u2010Xa adjusted low molecular weight heparin throughout pregnancy represents an effective anticoagulation option for low\u2010middle\u2010income countries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.15935","type":"journal-article","created":{"date-parts":[[2024,9,28]],"date-time":"2024-09-28T09:38:39Z","timestamp":1727516319000},"page":"1017-1025","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Anticoagulant therapy in pregnant women with mechanical and bioprosthetic heart valves"],"prefix":"10.1002","volume":"168","author":[{"given":"Haroun A.","family":"Rhemtula","sequence":"first","affiliation":[{"name":"Department of Obstetrics, Faculty of Health Sciences University of Witwatersrand Medical School  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1534-2930","authenticated-orcid":false,"given":"Elise","family":"Schapkaitz","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine and Hematology, Faculty of Health Sciences University of Witwatersrand Medical School  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barry","family":"Jacobson","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine and Hematology, Faculty of Health Sciences University of Witwatersrand Medical School  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence","family":"Chauke","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Faculty of Health Sciences University of Witwatersrand Medical School  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,9,28]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60696-6"},{"key":"e_1_2_8_3_1","unstructured":"National Committee for Confidential Enquiry into Maternal Deaths.Saving Mothers. 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