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이재관(JK Lee),김종화(JH Kim),강순범(SB Kang),김종환(JW Kim),서경필(KP Suh) 대한산부인과학회 1985 Obstetrics & Gynecology Science Vol.28 No.8
Patients who have had cardiac valve replacement are being seen increasingly often as candidates for antenatal care. The outcome of 23 pregnancies in 14 patients with bioprosthetic cardiac valves is analyzed and reported here. The results were summarized as follows: 1. Twenty three pregnancies in 14 patients with bioprosthetic cardiac valves resulted in 11 healthy, 2 low birth weight infants, 2 spontaneous abortions, 7 elective terminations of pregnancy, and one tubal pregnancy. 2. Pregnancy and labor seemed to have been tolerated relatively well in these patients. 3. There were 3 males and 10 females among the 13 infants born. 4. Birth weights ranged from 2,140 to 3,670g(mean 3,030). 5. Apgar scores at five minutes ranged from 4 to 10 (mean 9.1). 6. There were no instances of congenital malformations, maternal or fetal hemorrhagic complications. 7. There were 4 spontaneous vaginal deliveries, 7 elective vacuum extraction deliveries, 1 elective forcep delivery, and 1 cesarean section. 8. All patients received prophyllactic broad-spectrum antibiotics for infective endocarditis, and no nistances of endocarditis developed. 9. There were no stillbirth, no neonatal deaths, and no maternal deaths. 10. There were 2 instances of thromboembolism; one in the immediate postoperative period, and the other 5 years after valve replacement. All seemed to be unrelated to pregnancy. 11. Anticoagulants were not used in pregnancies which went to term except one patient, in whom coumarin was administered until 6th week of gestation. 12. One pregnancy was complicated with premature labor, one with gestational edema, one with preexisting chronic active hepatitis, five with worsening of cardiac status (one of the five, with newly developed atrial fibrillation). 13. 34.8% of all pregnancies after cardiac valve replacement were unwanted ones, and at the same time preventable `risk factors`.