Hey! I would love to share more of my story. I had my AVR in September 2010 at 24 years old. It was a difficult decision to get a mechanical valve, but I decided that I already had one miracle child and I wanted the best chances of staying with him. I knew it meant no more children and I struggled very much with the decision. My husband and I planned on adopting or fostering but it wasn't yet the right decision for our family. I pretty much gave up on having another child and had finally come to terms with it last winter when a pregnant friend and I were comparing pregnancies (My first and her most recent) and talking about medical advances and how quickly things change. So out of curiosity I started looking at current research about anti-coagulation and pregnancy as well as anti-coagulation in pregnancy with a mechanical valve. When I first did this research in 2010, I could not find any positive research on it. In late 2012 I was able to find a few studies that showed that although it was very risky, that it wasn't the death sentence that it was being made out to be. I found this pilot study that showed that low doses of warfarin appears to be safe for mother and baby.
http://www.ncbi.nlm.nih.gov/pubmed/22421305 While I cannot locate the other studies I found, I did find a few that studied using lovenox for the first trimester, warfarin for the second and most of the 3rd and heparin right before delivery.
At this point I realized that slowly research was starting to show that a safe pregnancy could be possible. Please understand that there are still a lot of risks involved, I am not saying this is risk free. I took what I found to my husband and we prayed about it and decided to meet with my OB and get an opinion on it. So we met with a highly recommended OB-GYN, and she found her own research. She felt as though the risks could be managed as well, but she also recommended that we meet with a doctor who specializes in Maternal-Fetal Medicine. She had one she recommended but said that she would refer me to any doctor I wanted. She also said that since most high risk doctor's will not take pregnant patients until after 14 weeks, she would be willing to take me as a patient until then. After this my husband and I decided to look for someone affiliated with Duke Hospital since I had my surgery there and it would be easiest with all the information in once place.
Around this time I met with my regular cardiologist for a scheduled check up. I talked to him about it. He told me that my heart was stronger and healthier than it had ever been. He said from a cardiology standpoint that his job was to say no simply to avoid being sued, however he said that if anyone could do it, it would be me, and that he was extremely interested in following the case.
We met with the maternal-fetal specialist for a consultation. He said once again it would be our choice and explained that the biggest risk would be clotting and stroke for me. He explained that this could be managed by either a low dose of warfarin throughout the whole pregnancy but this could have dangerous side effects for the baby, especially in the first trimester. They have pin-pointed the risk to be the greatest between 6-12 weeks. He said that I could also go on Heparin the entire pregnancy, but that Heparin can be unpredictable, and that there would be no risks for baby, but that risks could be high for me including clotting and stroke. Another alternate was switching to heparin or lovenox for weeks 6-12 and back to coumadin. The doctor knew a cardiologist who specializes in pregnant women with heart issues. He said that if I choose to get pregnant that he would schedule me to meet with her and as well as a hematologist.
So my husband and I had plenty of information but were still unsure of what to do. Until I had my annual check up with my surgical team. The doctor I spoke to casually asked me if I wanted more children and I looked at him like he was crazy. I told him that I did but that it was frowned upon. He also told me that after watching me for the last 3 years, that he felt like my body could handle it, and that with the right medical team he felt like it would be a real possibility for me. This decided it for my family. I felt that having several members of my conservative medical team encourage me without actually saying yes, and finally having this one telling me to go for it that maybe it could be a reality for me.
We were able to conceive fairly quickly, I kept very detailed records of my cycles and I started seeing the High-Risk Doctors at the Maternal-Fetal Medicine group at 4 weeks. The medical team decided that lovenox was the best option to start with and we started that shortly before 6 weeks. Lovenox is considered a much more stable option than heparin. I inject it twice a day. Around 12 weeks the medical team decided to continue with the lovenox for the remainder of the pregnancy. From this point baby and I were closely monitored. Baby has been through several rounds of testing for defects, especially any that may have been caused by warfarin for the short period of time. I have been working closely with a hematologist and my new cardiologist.
Meeting my new cardiologist was wonderful. I don't know how she found her niche but she works closely with pregnant women who have heart problems. She has actually worked with women with mechanical valves. She was very upbeat. She told me that after everyone else says no don't do it, she was the one who gets to say yes! She believed that with close monitoring and good medication management that I had a 90% chance of an uncomplicated delivery and recovery. She explained that I would have to be induced for labor and have the cardiologist and a hematologist on call for the induction. I would have to stop lovenox 12 hours before my induction and that I may be placed on LMWH heparin for part of the delivery. (I am still not sure what they decided on that one) The hematologist also explained that after delivery I would go back on Lovenox for 2 weeks during my transition back to coumadin.
Induction is now scheduled for December 29th. I hope to be able to report back to you and let you know what happened. In the meanwhile if anyone has questions I will do my best to answer them. Also if anyone is in the Duke area and would like referrals, I am willing to share that. For me this is a dream come true. I never even realized it was a possibility and now for me right now this is reality.
Here is our miracle child:
