Megumi (pseudonym), who had undergone heart valve replacement surgery, is pregnant, but pregnancy and delivery are extremely risky. A few days ago, under the full guarantee of the multidisciplinary team of Hubei Provincial Maternal and Child Health Care Hospital Optics Valley Campus, a healthy baby was successfully born in the mechanical heartbeat of the mother's "ticking". On March 23, before Xiaohui was discharged from the hospital, her husband handwrote a three-page thank you letter and a pennant of thanks to the medical team to express his gratitude.
Xiaohui's husband sent a pennant of thanks to the medical staff.
After a heart valve replacement, she became pregnant
Xiaohui, 33 years old this year, underwent mechanical heart valve replacement for acute endocarditis 6 years ago. After the operation, she slowly returned to her normal life and fell in love and got married; Becoming a mother is her greatest wish.
Last year, she became pregnant, but as a patient with a replacement heart, she required lifelong anticoagulation and was at potential risk of thromboembolism and bleeding. How to safely survive the entire pregnancy and successfully deliver a baby is a big challenge.
Xiaohui came to the Guanggu Branch of Hubei Provincial Maternal and Child Health Care Hospital to find Director Zhao Yun of the Department of Obstetrics. Under Zhao Yun's careful diagnosis and guidance, Xiaohui's pregnancy period was very stable. At 36 weeks of pregnancy, because her blood pressure gradually increased and her edema became increasingly obvious, Zhao Yun arranged for her to be hospitalized for elective cesarean section.
Pregnancy with a high risk of heart disease is one of the leading causes of maternal mortality. After admission, the Optics Valley campus organized a multidisciplinary joint consultation for Xiaohui, and the directors of adult intensive care medicine, surgical anesthesiology, neonatology, gynecology, surgery, medical imaging, ultrasonography, laboratory medicine, pharmacy and other departments gathered together to discuss Xiaohui's condition, and finally concluded that the pregnant woman's increased blood pressure and increased edema were signs of increased heart load and required cesarean section as soon as possible.
Multidisciplinary development of "seesaw" medication protocols
The care team develops a detailed treatment plan.
Surgery faces many difficulties. Because mechanical valves require long-term anticoagulation, in order to prevent bleeding, it is necessary to change the anticoagulant regimen before surgery, changing the long-term oral warfarin to low molecular weight heparin; In order to prevent thrombosis after surgery, anticoagulation therapy should be changed, and low molecular weight heparin should be changed back to warfarin. Preventing bleeding and preventing blood clots are like two ends of a "seesaw" that need to be balanced, and tilting either side will be fatal to Megumi's life.
At the same time, anticoagulation greatly increases the risk of bleeding and places high demands on cesarean section to stop bleeding; During and after surgery, they face a serious complication - mechanical valve thrombosis, once a large number of flaps are formed, the flap can lead to acute heart failure and endanger the life of the mother; The baby is born prematurely before 37 weeks, and the mother's long-term anticoagulation leads to vitamin K1 deficiency, intracranial hemorrhage, etc., which are full of risks.
To this end, experts from the hospital formulated detailed preoperative, intraoperative and postoperative treatment plans, including "seesaw" medication; Real-time monitoring of heart beats during surgery, surgical anesthesiology and adult intensive care doctors jointly guard Xiaohui's vital signs, medical imaging and blood transfusion departments also make plans to increase double insurance for hemostasis, and neonatology departments do a good job of baby health protection.
In the sound of mechanical heartbeat, the baby was born smoothly
At 8 o'clock on March 17, in the operating room of the Guanggu Campus of Hubei Provincial Maternal and Child Health Care Hospital, the directors of various departments arrived as scheduled, and everyone performed their duties according to the plan, all focusing on Xiaohui's heartbeat sound from the instrument and listening carefully to every rhythm. During the operation, as expected, bleeding was too much, Zhao Yun led the obstetrics team to quickly implement the operation, and with a cry, a 3150g baby boy was successfully delivered. The operation went smoothly, looking at the stable electrocardiogram on the instrument, everyone's hanging heart was slightly relaxed.
The health care team performs a caesarean section on the mother.
After the operation, Xiaohui was transferred to the adult intensive care department, and the child was transferred to the neonatal department. Experts formulated scientific and standardized anticoagulation therapy for her, and arranged obstetric nurses to assist ICU nurses to provide postpartum related care to Xiaohui. After learning that Xiaohui's family was impoverished due to illness, the hospital also specially applied for an aid fund for her.
Under the meticulous treatment and care of the medical staff, Xiaohui and the baby recovered smoothly, and the family of three was finally reunited.
Health care workers carry the newborn to the mother's bedside.
After the heart valve is replaced, the medication during pregnancy is exquisite
Patients who have undergone heart valve replacement should routinely take anticoagulant drugs after surgery to avoid embolic complications. In particular, lifelong anticoagulation is required after mechanical valve insertion. So, will oral anticoagulants affect pregnancy and childbirth in female patients of childbearing age?
Lu Jinguo, chief physician of the Department of Cardiology of Hubei Provincial Hospital of Integrated Traditional Chinese and Western Medicine, said that patients with biotic valves generally only need oral anticoagulant drugs for 3-6 months, so after stopping anticoagulants, women of childbearing age can get pregnant and give birth normally. However, it is necessary to do a good job of pregnancy health care to avoid cardiac insufficiency.
He reminded patients who replaced mechanical valves to take drugs such as fawarin for lifelong anticoagulation. Warfarin can pass through the placenta, causing various malformations in the fetus, or recurrent miscarriages, so it is best to switch to heparin drugs (such as heparin or low molecular weight heparin) to anticoagulate in the first 3 months of pregnancy. Between 12 and 36 weeks of pregnancy, warfarin can be used, the clotting time can be adjusted, and low molecular weight heparin can be continued, but monitoring is done. From 36 weeks of pregnancy to delivery, it is recommended to stop warfarin, because delivery may occur at any time, and in the case of warfarin, if it is delivered vaginally, there will be a risk of fetal cerebral hemorrhage, it is recommended to switch to low molecular weight heparin, and the same should be monitored. Discontinue 12 hours before delivery, and restore low molecular weight heparin as soon as possible after delivery, depending on postpartum haemorrhage, and gradually transition to warfarin.
Warfarin doesn't secrete from breast milk, so pregnant women who use warfarin can safely breastfeed, he said.
[Source: Yangtze River Daily-Changjiang Net]
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