Cardiology

Question 1

What are the risks of taking warfarin during pregnancy?

Answer 1

• Crosses the placenta
• Teratogenicity: <10%, greatest between 6-12 weeks gestation.
  
  • Chondromalacia punctata
  • Nasal and limb hypoplasia
• Miscarriage
• Intracranial haemorrhage and fetal death.

Question 2

Outline management plan for woman on warfarin anticoagulation for mechanical heart valve during labour and postpartum

Answer 2

• Stop warfarin 10-14 days prior to delivery to allow fetus to clear warfarin.
  
  • Warfarin can be reversed with FFP, prothrombinex and vitamin K.
• IOL at 39 weeks allows this to be timed.
• Cover with therapeutic clexane or UFH.
• Stop therapeutic clexane or UFH at labour/delivery.

Postpartum:

• Restart UFH after delivery.
• Restart warfarin 3-7 days postpartum.